Provider Demographics
NPI:1285098632
Name:PANOPOULOS, DINA JOHN (AUD)
Entity type:Individual
Prefix:
First Name:DINA
Middle Name:JOHN
Last Name:PANOPOULOS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2529 30TH DR
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-2747
Mailing Address - Country:US
Mailing Address - Phone:718-445-1312
Mailing Address - Fax:718-939-9877
Practice Address - Street 1:5528 MAIN ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5044
Practice Address - Country:US
Practice Address - Phone:718-445-1312
Practice Address - Fax:718-939-9877
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY57002624231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist