Provider Demographics
NPI:1851607675
Name:ANDREA, SHEILA DIANE (RT(R)(M))
Entity Type:Individual
Prefix:MS
First Name:SHEILA
Middle Name:DIANE
Last Name:ANDREA
Suffix:
Gender:F
Credentials:RT(R)(M)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11405 N CRESTVIEW ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-5215
Mailing Address - Country:US
Mailing Address - Phone:928-637-8724
Mailing Address - Fax:
Practice Address - Street 1:11405 N CRESTVIEW ST.
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-5215
Practice Address - Country:US
Practice Address - Phone:928-637-8724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCRT-13822247100000X
AZCMT-27392471M2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471M2300XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMammography
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist