1548551245 NPI number — MRS. ANDREA MARY CONNERY MS CCC SLP

Table of content: MRS. ANDREA MARY CONNERY MS CCC SLP (NPI 1548551245)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548551245 NPI number — MRS. ANDREA MARY CONNERY MS CCC SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONNERY
Provider First Name:
ANDREA
Provider Middle Name:
MARY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS CCC SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GRIFFITHS
Provider Other First Name:
ANDREA
Provider Other Middle Name:
MARY
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS CCC SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1548551245
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4937 SPRING ROAD
Provider Second Line Business Mailing Address:
PO BOX 168, MADISON ONELDA BOCES
Provider Business Mailing Address City Name:
VERONA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13478-0168
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-269-9997
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4937 SPRING ROAD
Provider Second Line Business Practice Location Address:
MADISON ONELDA BOCES
Provider Business Practice Location Address City Name:
VERONA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13478-0168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-361-5902
Provider Business Practice Location Address Fax Number:
315-361-5653
Provider Enumeration Date:
04/28/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  017466-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: NYS 017466-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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