Provider Demographics
NPI:1366992422
Name:GEORGIADIS, LYDIA MARIE (ANP)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:MARIE
Last Name:GEORGIADIS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 10TH ST
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14301-1882
Mailing Address - Country:US
Mailing Address - Phone:716-299-0524
Mailing Address - Fax:716-299-0737
Practice Address - Street 1:571 10TH ST
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301-1882
Practice Address - Country:US
Practice Address - Phone:716-299-0524
Practice Address - Fax:716-299-0737
Is Sole Proprietor?:No
Enumeration Date:2016-10-12
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307984363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health