Provider Demographics
NPI:1801936448
Name:ADIMANDO, ANDREA (APRN)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:
Last Name:ADIMANDO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 GOLDEN HILL LN
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-1674
Mailing Address - Country:US
Mailing Address - Phone:203-521-7424
Mailing Address - Fax:203-782-4725
Practice Address - Street 1:123 YORK ST
Practice Address - Street 2:SUITE 1D
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5614
Practice Address - Country:US
Practice Address - Phone:203-626-1311
Practice Address - Fax:203-782-4725
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003500363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health