Provider Demographics
NPI:1376946897
Name:ANDAYA, LYDIA KAY (IDC)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:KAY
Last Name:ANDAYA
Suffix:
Gender:F
Credentials:IDC
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:KAY
Other - Last Name:WILLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:IDC
Mailing Address - Street 1:400 DANDY LOOP RD
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23692-4513
Mailing Address - Country:US
Mailing Address - Phone:858-945-3080
Mailing Address - Fax:
Practice Address - Street 1:2220 SCHOFIELD RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23459
Practice Address - Country:US
Practice Address - Phone:757-763-4059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-29
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
No171000000XOther Service ProvidersMilitary Health Care Provider