Provider Demographics
NPI:1780471284
Name:REAGAN, ANDREW MALAY (PARAMEDIC (NRP))
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:MALAY
Last Name:REAGAN
Suffix:
Gender:
Credentials:PARAMEDIC (NRP)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 COLONIAL RD UNIT 101
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VT
Mailing Address - Zip Code:05454-9520
Mailing Address - Country:US
Mailing Address - Phone:651-329-6452
Mailing Address - Fax:
Practice Address - Street 1:350 S MAIN ST
Practice Address - Street 2:
Practice Address - City:STOWE
Practice Address - State:VT
Practice Address - Zip Code:05672-4489
Practice Address - Country:US
Practice Address - Phone:802-253-4315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT105274146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic