Provider Demographics
NPI:1942563549
Name:KANDEFER, TRICIA ANN
Entity Type:Individual
Prefix:MS
First Name:TRICIA
Middle Name:ANN
Last Name:KANDEFER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14379 ROUTE 9W
Mailing Address - Street 2:
Mailing Address - City:RAVENA
Mailing Address - State:NY
Mailing Address - Zip Code:12143-0000
Mailing Address - Country:US
Mailing Address - Phone:518-756-3124
Mailing Address - Fax:518-756-9476
Practice Address - Street 1:14379 ROUTE 9W
Practice Address - Street 2:
Practice Address - City:RAVENA
Practice Address - State:NY
Practice Address - Zip Code:12143-0000
Practice Address - Country:US
Practice Address - Phone:518-756-3124
Practice Address - Fax:518-756-9476
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1753277174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist