Provider Demographics
NPI:1548472186
Name:STEFANOU, KATERINA (BS)
Entity type:Individual
Prefix:MRS
First Name:KATERINA
Middle Name:
Last Name:STEFANOU
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:864 MIDDLE COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLE ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:11953-2524
Mailing Address - Country:US
Mailing Address - Phone:631-924-8500
Mailing Address - Fax:
Practice Address - Street 1:296 WEST PATCHOGUE
Practice Address - Street 2:
Practice Address - City:WEST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772
Practice Address - Country:US
Practice Address - Phone:631-654-1333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038631183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist