Provider Demographics
NPI:1437464443
Name:ANDAL, ELIZABETH MAALIHAN
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:MAALIHAN
Last Name:ANDAL
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:ANDAL
Other - Last Name:SORRENTINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, APRN-BC, PMHCNS
Mailing Address - Street 1:35 E HORIZON RIDGE PKWY
Mailing Address - Street 2:110-234
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89002-7905
Mailing Address - Country:US
Mailing Address - Phone:661-374-3971
Mailing Address - Fax:
Practice Address - Street 1:35 E HORIZON RIDGE PKWY
Practice Address - Street 2:110-234
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89002-7905
Practice Address - Country:US
Practice Address - Phone:661-374-3971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-13
Last Update Date:2012-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA324095101YM0800X, 163WP0808X
CACNS2651364SP0809X
CA186271363LP0808X
NVRN69037101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL304236700Medicaid
FL304236700Medicaid