Provider Demographics
NPI:1669910279
Name:ANDERSON, DAWN A (MS ED)
Entity type:Individual
Prefix:MS
First Name:DAWN
Middle Name:A
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:MS
Other - First Name:DAWN
Other - Middle Name:A
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSED
Mailing Address - Street 1:41 MAYER DR
Mailing Address - Street 2:PH
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-3349
Mailing Address - Country:US
Mailing Address - Phone:845-800-8919
Mailing Address - Fax:
Practice Address - Street 1:41 MAYER DR
Practice Address - Street 2:PH
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-3349
Practice Address - Country:US
Practice Address - Phone:845-800-8919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist