Provider Demographics
NPI:1740573559
Name:COSTELLO SCHILLING, ANDREA MICHELE (DAOM,LAC)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:MICHELE
Last Name:COSTELLO SCHILLING
Suffix:
Gender:
Credentials:DAOM,LAC
Other - Prefix:MRS
Other - First Name:ANDREA
Other - Middle Name:M
Other - Last Name:COSTELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2821 WEHRLE DR STE 9
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7386
Mailing Address - Country:US
Mailing Address - Phone:716-984-5575
Mailing Address - Fax:716-633-0600
Practice Address - Street 1:2821 WEHRLE DR STE 9
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7386
Practice Address - Country:US
Practice Address - Phone:716-984-5575
Practice Address - Fax:716-633-0600
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008828-01225700000X
NY25004571171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist