Provider Demographics
NPI:1457556870
Name:HARRIS, GYDA ANDREA
Entity Type:Individual
Prefix:
First Name:GYDA
Middle Name:ANDREA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GYDA
Other - Middle Name:ANDREA
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMP
Mailing Address - Street 1:1301 30TH ST
Mailing Address - Street 2:1301 30TH ST.
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-1001
Mailing Address - Country:US
Mailing Address - Phone:425-501-8662
Mailing Address - Fax:
Practice Address - Street 1:1301 30TH ST
Practice Address - Street 2:1301 30TH ST.
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-1001
Practice Address - Country:US
Practice Address - Phone:425-501-8662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist