1376289330 NPI number — ALEXIS YIANNA COLIANDRIS ME.D BCBA LABA

Table of content: ALEXIS YIANNA COLIANDRIS ME.D BCBA LABA (NPI 1376289330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376289330 NPI number — ALEXIS YIANNA COLIANDRIS ME.D BCBA LABA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLIANDRIS
Provider First Name:
ALEXIS
Provider Middle Name:
YIANNA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ME.D BCBA LABA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COLIANDRIS
Provider Other First Name:
ALEXIS
Provider Other Middle Name:
YIANNA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1376289330
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
155 MAIN DUNSTABLE RD, SUITE 150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHUA
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03060-3640
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
184-490-2422
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 PALOMINO LN STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEDFORD
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03110-6447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
184-490-2422
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/11/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103K00000X , with the licence number: 1-22-59123 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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