Provider Demographics
NPI:1700327038
Name:SUNDLOF-STOLLER, ANDREA (MS ED,MS CAS)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:
Last Name:SUNDLOF-STOLLER
Suffix:
Gender:F
Credentials:MS ED,MS CAS
Other - Prefix:MISS
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:SUNDLOF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:304 GREELEY ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-4852
Mailing Address - Country:US
Mailing Address - Phone:585-261-6939
Mailing Address - Fax:
Practice Address - Street 1:2111 HUDSON AVE
Practice Address - Street 2:
Practice Address - City:IRONDEQUOIT
Practice Address - State:NY
Practice Address - Zip Code:14617-4346
Practice Address - Country:US
Practice Address - Phone:585-261-6939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist