Provider Demographics
NPI:1124413281
Name:FIORILLO, ANDREA DEANNE (LMT, MMT)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:DEANNE
Last Name:FIORILLO
Suffix:
Gender:F
Credentials:LMT, MMT
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:DEANNE
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT, MMT
Mailing Address - Street 1:1421 KEMPSVILLE RD STE C
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-1406
Mailing Address - Country:US
Mailing Address - Phone:757-410-5322
Mailing Address - Fax:
Practice Address - Street 1:5265 PROVIDENCE RD
Practice Address - Street 2:SUITE 403
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-4206
Practice Address - Country:US
Practice Address - Phone:757-395-7887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-04
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019010290225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist