Provider Demographics
NPI:1710118781
Name:HERMAN, ANDREA E (RPA-C)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:E
Last Name:HERMAN
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:E
Other - Last Name:SHAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPA-C
Mailing Address - Street 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:1243 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:PINE CITY
Practice Address - State:NY
Practice Address - Zip Code:14871-9230
Practice Address - Country:US
Practice Address - Phone:607-734-3929
Practice Address - Fax:607-734-0781
Is Sole Proprietor?:No
Enumeration Date:2009-08-07
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013370363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03155548Medicaid
NY03155548Medicaid