Provider Demographics
NPI:1821627209
Name:DEANDREA, CHRISTINE EMILY (MPAS PA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:EMILY
Last Name:DEANDREA
Suffix:
Gender:F
Credentials:MPAS PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2591 WILDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ALLISON PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15101-2223
Mailing Address - Country:US
Mailing Address - Phone:412-303-3893
Mailing Address - Fax:
Practice Address - Street 1:2575 BOYCE PLAZA RD
Practice Address - Street 2:
Practice Address - City:UPPER ST CLAIR
Practice Address - State:PA
Practice Address - Zip Code:15241-3994
Practice Address - Country:US
Practice Address - Phone:412-257-2290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA061507363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA061507OtherPENNSYLVANIA STATE DEPARTMENT OF MEDICINE, PHYSICIAN ASSISTANT L