Provider Demographics
NPI:1679833792
Name:SPATARELLA, ANDREA M (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:M
Last Name:SPATARELLA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 LAKEVILLE RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1121
Mailing Address - Country:US
Mailing Address - Phone:718-470-4641
Mailing Address - Fax:516-328-1447
Practice Address - Street 1:400 LAKEVILLE RD
Practice Address - Street 2:SUITE 220
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1121
Practice Address - Country:US
Practice Address - Phone:718-470-4641
Practice Address - Fax:516-328-1447
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333399363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily