Provider Demographics
NPI:1780294199
Name:CANDELORE, ANDREW JOHN (DNP, CRNA)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:JOHN
Last Name:CANDELORE
Suffix:
Gender:M
Credentials:DNP, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 MORRIS ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-2009
Mailing Address - Country:US
Mailing Address - Phone:484-744-3714
Mailing Address - Fax:
Practice Address - Street 1:2500 BERNVILLE RD
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19605-9453
Practice Address - Country:US
Practice Address - Phone:610-378-2055
Practice Address - Fax:610-378-2058
Is Sole Proprietor?:No
Enumeration Date:2020-08-01
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0051674163W00000X
DEL6-0A10834367500000X
PARN639064367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse