MEDICARE: MALVINA VASILIKI MARIA LORIDA

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
1	171100000X	Acupuncturist	007717	NY
2	171100000X	Acupuncturist	091.0134127PROV	VT
3	171100000X	Acupuncturist	091.0134128	VT

General Provider Information

NPI Number	:	1760377576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALVINA VASILIKI MARIA LORIDA

Provider Business Mailing Address
First Line	:	12A WOLVEN LN
Second Line	:
City	:	WOODSTOCK
State	:	NY
Zip	:	12498-1139
Country	:	US
Telephone Number	:	475-298-8224
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 SAINT PAUL ST STE 323
Second Line	:
City	:	BURLINGTON
State	:	VT
Zip	:	05401-5073
Country	:	US
Telephone Number	:	802-222-0436
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2025
Last Update Date	:	06/12/2025

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Directions to “ MALVINA VASILIKI MARIA LORIDA ” Practice Location

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