Provider Demographics
NPI:1659429702
Name:ATTARDO, ANDREA J (NP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:J
Last Name:ATTARDO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 COATES DR
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-6758
Mailing Address - Country:US
Mailing Address - Phone:845-651-1412
Mailing Address - Fax:845-651-1512
Practice Address - Street 1:1460 ROUTE 17M
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10918-1054
Practice Address - Country:US
Practice Address - Phone:845-469-4211
Practice Address - Fax:845-469-2339
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF304551363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY324475OtherRN LICENSE
NY324475OtherRN LICENSE