Provider Demographics
NPI:1598140097
Name:OSHIOTSE, ANDY OSHIOPEKHAI (LPN)
Entity Type:Individual
Prefix:MR
First Name:ANDY
Middle Name:OSHIOPEKHAI
Last Name:OSHIOTSE
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 CAITLIN TRL
Mailing Address - Street 2:
Mailing Address - City:WEST HENRIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:14586-8911
Mailing Address - Country:US
Mailing Address - Phone:646-226-2198
Mailing Address - Fax:
Practice Address - Street 1:116 CAITLIN TRL
Practice Address - Street 2:
Practice Address - City:WEST HENRIETTA
Practice Address - State:NY
Practice Address - Zip Code:14586-8911
Practice Address - Country:US
Practice Address - Phone:646-226-2198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-25
Last Update Date:2015-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308566-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse