Provider Demographics
NPI:1205880762
Name:SKILLMAN, ANDREA L (PA)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:SKILLMAN
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:25 WILLOWBROOK ROAD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-3137
Mailing Address - Country:US
Mailing Address - Phone:518-793-9156
Mailing Address - Fax:518-793-6591
Practice Address - Street 1:25 WILLOWBROOK ROAD
Practice Address - Street 2:SUITE 2
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-0000
Practice Address - Country:US
Practice Address - Phone:518-793-9156
Practice Address - Fax:518-793-6591
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2016-08-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY0093711363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1559Medicare PIN