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General NPI Number Information
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NPI Number | 1205102050
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Entity Type | Individual
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Provider Name | ANGELIKI ANASTASIA MITSIANIS
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Gender | Female
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Dates
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Enumeration Date | 03/27/2012
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 201 E BROAD ST STE C
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City | SPARTANBURG
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State | SC
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Zip | 29306-3233
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Country | US
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Telephone | 864-202-2690
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Fax |
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Provider Business Mailing Address
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Address Line | 208 NORTH ST
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City | SPARTANBURG
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State | SC
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Zip | 29306-4638
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Country | US
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Telephone | 914-886-5220
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SLP.7854
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License Number State | SC
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