Provider Demographics
NPI:1891923793
Name:ANDOLA, ISRAEL WHEELER (PA)
Entity Type:Individual
Prefix:MRS
First Name:ISRAEL
Middle Name:WHEELER
Last Name:ANDOLA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ISRAEL
Other - Middle Name:
Other - Last Name:WHEELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:204 WARDWELL ST UNIT 5
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-5247
Mailing Address - Country:US
Mailing Address - Phone:919-622-0852
Mailing Address - Fax:
Practice Address - Street 1:346 MAIN AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-1592
Practice Address - Country:US
Practice Address - Phone:203-846-0005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013378363AM0700X
CT2278363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY013378OtherNY LICENSE
1084159OtherNCCPA NUMBER
CT002278OtherCT LICENSE