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General NPI Number Information
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NPI Number | 1356582530
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Entity Type | Individual
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Provider Name | JEANNE VASILAKIS NP
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Gender | Female
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Dates
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Enumeration Date | 03/17/2009
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Last Update Date | 03/17/2009
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Provider Practice Location Address
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Address Line | 410 LAKEVILLE RD
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City | NEW HYDE PARK
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State | NY
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Zip | 11042-1101
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Country | US
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Telephone | 516-465-5219
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Fax | 516-465-5299
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Provider Business Mailing Address
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Address Line | 3994 PARK AVE
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City | SEAFORD
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State | NY
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Zip | 11783-2338
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Country | US
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Telephone | 516-785-2063
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Fax | 516-465-5299
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | F380403
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License Number State | NY
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