Provider Demographics
NPI:1689038549
Name:PAPASTAVROS, VASSILIKI
Entity type:Individual
Prefix:
First Name:VASSILIKI
Middle Name:
Last Name:PAPASTAVROS
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 1:2370 SW 131ST TER
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-5136
Mailing Address - Country:US
Mailing Address - Phone:954-632-7854
Mailing Address - Fax:
Practice Address - Street 1:9050 PINES BLVD STE 200
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6456
Practice Address - Country:US
Practice Address - Phone:954-433-0455
Practice Address - Fax:954-433-8771
Is Sole Proprietor?:No
Enumeration Date:2016-04-07
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME148876207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology