Provider Demographics
NPI:1679617021
Name:SLAZYK, ANDREA L (NP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:SLAZYK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 INTERNATIONAL LN
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-1474
Mailing Address - Country:US
Mailing Address - Phone:716-774-0034
Mailing Address - Fax:
Practice Address - Street 1:60 INNSBRUCK DR
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14227-2735
Practice Address - Country:US
Practice Address - Phone:716-669-7051
Practice Address - Fax:716-668-7059
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304590363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health