MEDICARE: SAVANNAH PATSAKOS

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1932917077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAVANNAH PATSAKOS

Provider Business Mailing Address
First Line	:	296 MARYLAND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-2917
Country	:	US
Telephone Number	:	917-808-0939
Fax Number	:

Provider Business Practice Location Address
First Line	:	296 MARYLAND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-2917
Country	:	US
Telephone Number	:	917-808-0939
Fax Number	:

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

Provider Enumeration Date	:	12/20/2024
Last Update Date	:	12/20/2024

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Directions to “ SAVANNAH PATSAKOS ” Practice Location

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