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NPI Code Detail

MEDICARE: STEFAN DOMENIKOS

MEDICARE: STEFAN DOMENIKOS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse084242-21NH

General Provider Information

NPI Number : 1689502866
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEFAN DOMENIKOS
Provider Business Mailing Address
First Line : 45 POINTE PL
Second Line :
City : DOVER
State : NH
Zip : 03820-4769
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 333 BORTHWICK AVE
Second Line :
City : PORTSMOUTH
State : NH
Zip : 03801-7128
Country : US
Telephone Number : 603-436-5110
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2026
Last Update Date : 05/11/2026

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Directions to “ STEFAN DOMENIKOS ” Practice Location

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