Provider Demographics
NPI:1508419144
Name:CHIK, ANDREA S (APRN)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:S
Last Name:CHIK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 COALPIT HILL RD UNIT 21
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-8016
Mailing Address - Country:US
Mailing Address - Phone:203-947-9363
Mailing Address - Fax:
Practice Address - Street 1:75 WEST ST
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6528
Practice Address - Country:US
Practice Address - Phone:203-748-5689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-23
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8396363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty