Provider Demographics
NPI:1235621392
Name:DASSIE, ANDREA MONIQUE
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MONIQUE
Last Name:DASSIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 LINDSLEY AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-3315
Mailing Address - Country:US
Mailing Address - Phone:845-616-1178
Mailing Address - Fax:
Practice Address - Street 1:344 GIDNEY AVE
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-3330
Practice Address - Country:US
Practice Address - Phone:845-562-6220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027714235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist