Provider Demographics
NPI:1235467952
Name:MASTANDREA, ALISON ROBIN (RN)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:ROBIN
Last Name:MASTANDREA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 BUCK BROOK RD
Mailing Address - Street 2:
Mailing Address - City:ROSCOE
Mailing Address - State:NY
Mailing Address - Zip Code:12776-5612
Mailing Address - Country:US
Mailing Address - Phone:845-482-5431
Mailing Address - Fax:845-482-9054
Practice Address - Street 1:241 BUCK BROOK RD
Practice Address - Street 2:
Practice Address - City:ROSCOE
Practice Address - State:NY
Practice Address - Zip Code:12776-5612
Practice Address - Country:US
Practice Address - Phone:845-482-5431
Practice Address - Fax:845-482-9054
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY507691-1163WG0000X, 163WM0705X
PARN-578757163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice