Provider Demographics
NPI:1326874678
Name:LIOTOPOULOS, ANASTASIA MARIA (CPNP-PC)
Entity type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:MARIA
Last Name:LIOTOPOULOS
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4311 195TH ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-3518
Mailing Address - Country:US
Mailing Address - Phone:917-502-2409
Mailing Address - Fax:
Practice Address - Street 1:21031 26TH AVE
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-1949
Practice Address - Country:US
Practice Address - Phone:718-747-5437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-12
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF383688363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics