Provider Demographics
NPI:1063134849
Name:NIKOLAIDIS, ALEXANDRA (SLP- CCC)
Entity type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:
Last Name:NIKOLAIDIS
Suffix:
Gender:F
Credentials:SLP- CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3634
Mailing Address - Country:US
Mailing Address - Phone:917-558-6921
Mailing Address - Fax:
Practice Address - Street 1:124 CHAPEL RD
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3634
Practice Address - Country:US
Practice Address - Phone:917-558-6921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029771-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist