Healthcare Provider Details

I. General information

NPI: 1235491648
Provider Name (Legal Business Name): CHRISTINA MICHAELIDES MS.SPED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 06/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 EXECUTIVE DR
PLAINVIEW NY
11803-1718
US

IV. Provider business mailing address

2572 12TH ST
ASTORIA NY
11102-3726
US

V. Phone/Fax

Practice location:
  • Phone: 516-349-0961
  • Fax:
Mailing address:
  • Phone: 917-817-6978
  • Fax: 718-925-0360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number1678668
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: