Provider Demographics
NPI:1215245220
Name:MICHAELIDES, ANDREAS COSTAS (PHD)
Entity type:Individual
Prefix:DR
First Name:ANDREAS
Middle Name:COSTAS
Last Name:MICHAELIDES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 ROUTE 111
Mailing Address - Street 2:SUITE 10
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-4759
Mailing Address - Country:US
Mailing Address - Phone:631-240-3030
Mailing Address - Fax:
Practice Address - Street 1:373 ROUTE 111
Practice Address - Street 2:SUITE 10
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-4759
Practice Address - Country:US
Practice Address - Phone:631-540-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist