Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Ellie Theodorakis, PA-C

Individual provider Physician Assistant · NPI 1669178083

Ellie Theodorakis, PA-C is a Physician Assistant in Jamaica, New York. Qualified in 2023, 3 years ago. Practices with Kings Physician Services PC, a 645-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
3
Licensed in
NY
In the registry since
2023
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

9420 Guy R Brewer Blvd
Jamaica, NY 11451-0002
Phone: (718) 262-2000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 029649 (NY)

Record details

NPI number1669178083
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorYes
NPI enumeratedFebruary 7, 2023
Last updated in NPPESJuly 14, 2025
Certification dateJuly 14, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Kings Physician Services Pc — 645 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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