Provider Demographics
NPI:1376944991
Name:SCANDAGLIA, ANDREA
Entity Type:Individual
Prefix:MISS
First Name:ANDREA
Middle Name:
Last Name:SCANDAGLIA
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 1:2025 RICHMOND AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3937
Mailing Address - Country:US
Mailing Address - Phone:800-314-8078
Mailing Address - Fax:718-228-4226
Practice Address - Street 1:62 SEIDMAN AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-5025
Practice Address - Country:US
Practice Address - Phone:347-217-2250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-15
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY188984327174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist