Provider Demographics
NPI:1356968085
Name:DOSSANTOS, ANDREA MARIE
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARIE
Last Name:DOSSANTOS
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 1:654 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ASBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08802-1353
Mailing Address - Country:US
Mailing Address - Phone:908-892-9723
Mailing Address - Fax:
Practice Address - Street 1:17 LEGION PL
Practice Address - Street 2:
Practice Address - City:ROCHELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07662-3209
Practice Address - Country:US
Practice Address - Phone:201-843-3274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00899000225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist