Provider Demographics
NPI:1760377576
Name:LORIDA, MALVINA VASILIKI MARIA
Entity type:Individual
Prefix:
First Name:MALVINA
Middle Name:VASILIKI MARIA
Last Name:LORIDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12A WOLVEN LN
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:NY
Mailing Address - Zip Code:12498-1139
Mailing Address - Country:US
Mailing Address - Phone:475-298-8224
Mailing Address - Fax:
Practice Address - Street 1:305 SAINT PAUL ST STE 323
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-5073
Practice Address - Country:US
Practice Address - Phone:802-222-0436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-11
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007717171100000X
VT091.0134127PROV171100000X
VT091.0134128171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist