Provider Demographics
NPI:1740573559
Name:COSTELLO SCHILLING, ANDREA MICHELE (MA,LAC)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:MICHELE
Last Name:COSTELLO SCHILLING
Suffix:
Gender:F
Credentials:MA,LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5859 TRANSIT RD
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-1885
Mailing Address - Country:US
Mailing Address - Phone:716-688-1768
Mailing Address - Fax:716-688-1768
Practice Address - Street 1:5859 TRANSIT RD
Practice Address - Street 2:
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-1885
Practice Address - Country:US
Practice Address - Phone:716-688-1768
Practice Address - Fax:716-688-1768
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25004571171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist