Provider Demographics
NPI:1508401449
Name:AKYEAMPONG, ANDREA
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:AKYEAMPONG
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 1:220 CAMPUS BLVD STE 320
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2889
Mailing Address - Country:US
Mailing Address - Phone:540-536-5100
Mailing Address - Fax:540-536-0235
Practice Address - Street 1:120 CAMPUS DR STE 211
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-7561
Practice Address - Country:US
Practice Address - Phone:681-247-1260
Practice Address - Fax:681-247-1261
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV34292207Q00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician