Provider Demographics
NPI:1710103908
Name:POWELL, M ANDREA (RPA-C)
Entity Type:Individual
Prefix:
First Name:M ANDREA
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4422 THIRD AVE
Mailing Address - Street 2:ST BARNABAS HOSPITAL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10457
Mailing Address - Country:US
Mailing Address - Phone:718-960-6133
Mailing Address - Fax:
Practice Address - Street 1:4422 THIRD AVE
Practice Address - Street 2:ST BARNABAS HOSPITAL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10457
Practice Address - Country:US
Practice Address - Phone:718-960-6133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008559363A00000X
IL085004223363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant