Provider Demographics
NPI:1679824833
Name:IOANNOU, LILYANN (MSED)
Entity type:Individual
Prefix:MS
First Name:LILYANN
Middle Name:
Last Name:IOANNOU
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3094 45TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-1849
Mailing Address - Country:US
Mailing Address - Phone:917-217-4592
Mailing Address - Fax:
Practice Address - Street 1:3094 45TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-1849
Practice Address - Country:US
Practice Address - Phone:917-217-4592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2402923174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist