Provider Demographics
NPI:1447701263
Name:ANDRADE, DENISSE (PA-C)
Entity type:Individual
Prefix:
First Name:DENISSE
Middle Name:
Last Name:ANDRADE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6843 BURNS ST APT E2
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5092
Mailing Address - Country:US
Mailing Address - Phone:772-834-0534
Mailing Address - Fax:
Practice Address - Street 1:6843 BURNS ST APT E2
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-5092
Practice Address - Country:US
Practice Address - Phone:772-834-0534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020297363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical