Healthcare Provider Details

I. General information

NPI: 1184845661
Provider Name (Legal Business Name): THERESA MARIE VLAHOS N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STONYBROOK UNIVERSITY MEDICAL CTR SUNY - 9440
STONY BROOK NY
11794-9440
US

IV. Provider business mailing address

58 HILDEN ST
KINGS PARK NY
11754-1768
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-9267
  • Fax: 631-444-1211
Mailing address:
  • Phone: 631-444-9267
  • Fax: 631-444-1211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF300544-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF381179-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: