Provider Demographics
NPI:1396990057
Name:SKAFIDAS, NICOLAS (MA OTR/L)
Entity type:Individual
Prefix:MR
First Name:NICOLAS
Middle Name:
Last Name:SKAFIDAS
Suffix:
Gender:M
Credentials:MA OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16216 65TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11365-1813
Mailing Address - Country:US
Mailing Address - Phone:917-270-7244
Mailing Address - Fax:718-353-2127
Practice Address - Street 1:16216 65TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11365-1813
Practice Address - Country:US
Practice Address - Phone:917-270-7244
Practice Address - Fax:718-353-2127
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-22
Last Update Date:2008-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012306225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist