Provider Demographics
NPI:1316005507
Name:SCHAEFFER, ANDREA JOY (RD, CDN)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:JOY
Last Name:SCHAEFFER
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 VISTA HILL RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-1526
Mailing Address - Country:US
Mailing Address - Phone:516-375-9029
Mailing Address - Fax:
Practice Address - Street 1:2322 30TH AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-3255
Practice Address - Country:US
Practice Address - Phone:718-956-7988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000208-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2116288OtherVYTRA
NY2456408OtherUNITED HEALTHCARE
NY8099779OtherGHI
NYP2694450OtherOXFORD HEALTH CARE
NY2456408OtherUNITED HEALTHCARE
NYP2694450OtherOXFORD HEALTH CARE