Provider Demographics
NPI:1285220293
Name:WHEELOCK, ANDREW LLOYD III
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:LLOYD
Last Name:WHEELOCK
Suffix:III
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 1:121 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13452-1021
Mailing Address - Country:US
Mailing Address - Phone:518-332-5040
Mailing Address - Fax:
Practice Address - Street 1:121 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SAINT JOHNSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13452-1021
Practice Address - Country:US
Practice Address - Phone:518-332-5040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant