Provider Demographics
NPI:1174577746
Name:GAVALAKIS, NELLY (APN-C)
Entity type:Individual
Prefix:
First Name:NELLY
Middle Name:
Last Name:GAVALAKIS
Suffix:
Gender:F
Credentials:APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 RAINBOW TER
Mailing Address - Street 2:
Mailing Address - City:BLACK MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28711-8439
Mailing Address - Country:US
Mailing Address - Phone:917-757-7261
Mailing Address - Fax:
Practice Address - Street 1:155 POLIFLY RD STE 112
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1749
Practice Address - Country:US
Practice Address - Phone:201-996-8840
Practice Address - Fax:201-441-9949
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5021153363LP0200X
NJ20050002363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics