Provider Demographics
NPI:1649434614
Name:SCIAMMARELLA, ANDREA (MD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:SCIAMMARELLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 E ORMAN AVE STE G12
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-3563
Mailing Address - Country:US
Mailing Address - Phone:719-564-1800
Mailing Address - Fax:719-564-1865
Practice Address - Street 1:1925 E ORMAN AVE STE G12
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-3563
Practice Address - Country:US
Practice Address - Phone:719-564-1800
Practice Address - Fax:719-564-1865
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR00492932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO40622282Medicaid