Provider Demographics
NPI:1417113796
Name:SCRIVO, ANDREA P (OTR)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:P
Last Name:SCRIVO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7159 MARIGOLD DR
Mailing Address - Street 2:
Mailing Address - City:N TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-1262
Mailing Address - Country:US
Mailing Address - Phone:716-743-0079
Mailing Address - Fax:
Practice Address - Street 1:1360 EGGERT RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-3354
Practice Address - Country:US
Practice Address - Phone:716-835-0417
Practice Address - Fax:716-835-2648
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003374-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist