Provider Demographics
NPI:1346767209
Name:DROSDOWICH, AUDRA SUE (PA)
Entity Type:Individual
Prefix:
First Name:AUDRA
Middle Name:SUE
Last Name:DROSDOWICH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AUDRA
Other - Middle Name:SUE
Other - Last Name:VANDYKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:45 READE PL
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-3947
Mailing Address - Country:US
Mailing Address - Phone:845-475-9635
Mailing Address - Fax:845-475-9938
Practice Address - Street 1:45 READE PL
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-3947
Practice Address - Country:US
Practice Address - Phone:845-475-9635
Practice Address - Fax:845-475-9938
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601008375363A00000X
NY030568363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant