Provider Demographics
NPI:1194991794
Name:PETRIDOU, PARIS AUGUSTINE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:PARIS
Middle Name:AUGUSTINE
Last Name:PETRIDOU
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 AQUEDUCT PL
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-1610
Mailing Address - Country:US
Mailing Address - Phone:914-406-3410
Mailing Address - Fax:
Practice Address - Street 1:2 AQUEDUCT PL
Practice Address - Street 2:
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567-1610
Practice Address - Country:US
Practice Address - Phone:914-406-3410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-02
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014632235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist