1700327038 NPI number — MRS. ANDREA SUNDLOF-STOLLER M.S. ED,M.S. C.A.S

Table of content: MRS. ANDREA SUNDLOF-STOLLER M.S. ED,M.S. C.A.S (NPI 1700327038)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700327038 NPI number — MRS. ANDREA SUNDLOF-STOLLER M.S. ED,M.S. C.A.S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUNDLOF-STOLLER
Provider First Name:
ANDREA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S. ED,M.S. C.A.S
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SUNDLOF
Provider Other First Name:
ANDREA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1700327038
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/20/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
304 GREELEY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14609-4852
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-261-6939
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2111 HUDSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRONDEQUOIT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14617-4346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-261-6939
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/20/2017

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: 174400000X , 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)