Provider Demographics
NPI:1871565598
Name:BOYD, ANDREA L (SPA-C)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:BOYD
Suffix:
Gender:F
Credentials:SPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7255 OLD OAK BLVD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3300
Mailing Address - Country:US
Mailing Address - Phone:440-891-8878
Mailing Address - Fax:
Practice Address - Street 1:7255 OLD OAK BLVD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-3329
Practice Address - Country:US
Practice Address - Phone:440-891-8878
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-00-1351363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00242414OtherRAILROAD MEDICARE
OH52954OtherQUAL CHOICE
OH0835127Medicaid
OH0000000378376OtherANTHEM
OH2968745919-00OtherBWC
OH100524842011OtherMEDICAL MUTUAL
OH4078243OtherAETNA
OH0835127Medicaid
OHP00242414OtherRAILROAD MEDICARE
OHS86154Medicare UPIN