Provider Demographics
NPI:1205080389
Name:D'ANDREA, ANNIKA T
Entity type:Individual
Prefix:MRS
First Name:ANNIKA
Middle Name:T
Last Name:D'ANDREA
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 1:1330 DRAKE RD
Mailing Address - Street 2:
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420-9646
Mailing Address - Country:US
Mailing Address - Phone:585-754-3121
Mailing Address - Fax:
Practice Address - Street 1:1330 DRAKE RD
Practice Address - Street 2:
Practice Address - City:BROCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14420-9646
Practice Address - Country:US
Practice Address - Phone:585-754-3121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-16
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X, 172A00000X, 171R00000X, 225A00000X, 225100000X, 372500000X, 372600000X, 374T00000X, 376J00000X, 376K00000X
NY293075-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No172A00000XOther Service ProvidersDriver
No171R00000XOther Service ProvidersInterpreter
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide