Healthcare Provider Details

I. General information

NPI: 1801266705
Provider Name (Legal Business Name): NIKI IOANNOU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2015
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16012 CRYDERS LN
WHITESTONE NY
11357-2740
US

IV. Provider business mailing address

102 BOULDER RD
MANHASSET NY
11030-1632
US

V. Phone/Fax

Practice location:
  • Phone: 917-853-4475
  • Fax:
Mailing address:
  • Phone: 917-853-4475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number491700-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number381599
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: