Provider Demographics
NPI:1811396864
Name:MCCLOY, ANDREA MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARIE
Last Name:MCCLOY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11709-2017
Mailing Address - Country:US
Mailing Address - Phone:163-174-5745
Mailing Address - Fax:
Practice Address - Street 1:1129 NORTHERN BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3045
Practice Address - Country:US
Practice Address - Phone:151-636-5577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY336307363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily