Provider Demographics
NPI:1033525183
Name:FAIELLA, ANDREW
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:FAIELLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 W FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-3140
Mailing Address - Country:US
Mailing Address - Phone:480-459-6820
Mailing Address - Fax:480-969-5353
Practice Address - Street 1:323 E BROWN RD
Practice Address - Street 2:204
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-3544
Practice Address - Country:US
Practice Address - Phone:480-459-6820
Practice Address - Fax:480-969-5353
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor