Provider Demographics
NPI:1942228861
Name:STREETER, ANYA S (MD)
Entity Type:Individual
Prefix:DR
First Name:ANYA
Middle Name:S
Last Name:STREETER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 ELK LN
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-4412
Mailing Address - Country:US
Mailing Address - Phone:802-878-2383
Mailing Address - Fax:
Practice Address - Street 1:883 BLAKELY RD
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-4417
Practice Address - Country:US
Practice Address - Phone:802-847-2055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420010843207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1010932Medicaid
NY02622122Medicaid
VTVN3554Medicare ID - Type Unspecified
NY02622122Medicaid