Provider Demographics
NPI:1215244645
Name:CAMBOURAKIS, THEODORA (MA, CCC-SLP, TSSLD)
Entity type:Individual
Prefix:
First Name:THEODORA
Middle Name:
Last Name:CAMBOURAKIS
Suffix:
Gender:F
Credentials:MA, CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:DORIE
Other - Middle Name:
Other - Last Name:CAMBOURAKIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7161 DOUGLASTON PKWY
Mailing Address - Street 2:
Mailing Address - City:DOUGLASTON
Mailing Address - State:NY
Mailing Address - Zip Code:11362-1936
Mailing Address - Country:US
Mailing Address - Phone:347-229-2601
Mailing Address - Fax:
Practice Address - Street 1:17045 84TH AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-2105
Practice Address - Country:US
Practice Address - Phone:718-480-2840
Practice Address - Fax:718-658-5690
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-07
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019118235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist