Provider Demographics
NPI:1700493491
Name:KINGDON, ANDREW THOMAS
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:THOMAS
Last Name:KINGDON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 BENT OAK TRL
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-8949
Mailing Address - Country:US
Mailing Address - Phone:760-470-3094
Mailing Address - Fax:
Practice Address - Street 1:91 BENT OAK TRL
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-8949
Practice Address - Country:US
Practice Address - Phone:760-470-3094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-26
Last Update Date:2020-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer