Provider Demographics
NPI:1467711135
Name:KUDEL, ANDREA NAOMI (DO)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:NAOMI
Last Name:KUDEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:8745 LAKE STREET RD
Mailing Address - Street 2:
Mailing Address - City:LE ROY
Mailing Address - State:NY
Mailing Address - Zip Code:14482-9344
Mailing Address - Country:US
Mailing Address - Phone:585-768-2620
Mailing Address - Fax:585-768-2694
Practice Address - Street 1:8745 LAKE STREET RD
Practice Address - Street 2:
Practice Address - City:LE ROY
Practice Address - State:NY
Practice Address - Zip Code:14482-9344
Practice Address - Country:US
Practice Address - Phone:585-768-2620
Practice Address - Fax:585-768-2694
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY279092207Q00000X
NY279092-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine