Provider Demographics
NPI:1518344357
Name:ANDRIA, WENDI (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:WENDI
Middle Name:
Last Name:ANDRIA
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 CLOVERWOOD PL
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-4617
Mailing Address - Country:US
Mailing Address - Phone:631-707-6598
Mailing Address - Fax:
Practice Address - Street 1:19 CLOVERWOOD PL
Practice Address - Street 2:
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-4617
Practice Address - Country:US
Practice Address - Phone:631-707-6598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22 505882163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant