Provider Demographics
NPI:1023370319
Name:COLANDRA, ADISATU A (RN)
Entity Type:Individual
Prefix:MS
First Name:ADISATU
Middle Name:A
Last Name:COLANDRA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:ADISATU
Other - Middle Name:A
Other - Last Name:MOSES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:185 PARK HILL AVE APT 2O
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-4732
Mailing Address - Country:US
Mailing Address - Phone:347-469-7792
Mailing Address - Fax:
Practice Address - Street 1:185 PARK HILL AVE APT 2O
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-4732
Practice Address - Country:US
Practice Address - Phone:347-469-7792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY650128163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse