Provider Demographics
NPI:1952639015
Name:DE ANDRADE, LAURA (NP)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:DE ANDRADE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 JENNA DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-5341
Mailing Address - Country:US
Mailing Address - Phone:914-643-8548
Mailing Address - Fax:
Practice Address - Street 1:156 ROUTE 59
Practice Address - Street 2:A2
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-5005
Practice Address - Country:US
Practice Address - Phone:845-517-2870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-01
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305230363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health