Provider Demographics
NPI:1578801130
Name:VILARDI, ANDRE (RN)
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:
Last Name:VILARDI
Suffix:
Gender:F
Credentials:RN
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 455
Mailing Address - Street 2:
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-0455
Mailing Address - Country:US
Mailing Address - Phone:631-338-5258
Mailing Address - Fax:
Practice Address - Street 1:15 VAN BRUNT MANOR RD
Practice Address - Street 2:
Practice Address - City:SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3936
Practice Address - Country:US
Practice Address - Phone:631-338-5258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY466198163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse