Basic Information
| Provider Information | |||||||||
| NPI: | 1477169969 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HIONIDIS | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | KATARINA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1605 N CEDAR CREST BLVD STE 411 | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181042323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4846292282 | ||||||||
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| Practice Location | |||||||||
| Address1: | 334 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | DICKSON CITY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 185191668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5703071767 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2020 | ||||||||
| LastUpdateDate: | 05/05/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | MA0619857 | PA | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 363AS0400X | MA0619857 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | MA061857 | 01 | PA | STATE LICENSE | OTHER |