Provider Demographics
NPI:1447569199
Name:DANDREA, LISA A (SLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:DANDREA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1200
Mailing Address - Street 2:
Mailing Address - City:AQUEBOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11931-1200
Mailing Address - Country:US
Mailing Address - Phone:631-369-6779
Mailing Address - Fax:
Practice Address - Street 1:499 MAIN RD
Practice Address - Street 2:
Practice Address - City:AQUEBOGUE
Practice Address - State:NY
Practice Address - Zip Code:11931-1200
Practice Address - Country:US
Practice Address - Phone:631-369-6779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007991-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist