MEDICARE: DR. ANDREA ANNIBALE PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1528795721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREA ANNIBALE PSYD

Provider Business Mailing Address
First Line	:	8652 E EASTRIDGE RD STE 201
Second Line	:
City	:	PRESCOTT VALLEY
State	:	AZ
Zip	:	86314-9464
Country	:	US
Telephone Number	:	928-830-2410
Fax Number	:

Provider Business Practice Location Address
First Line	:	8652 E EASTRIDGE RD STE 201
Second Line	:
City	:	PRESCOTT VALLEY
State	:	AZ
Zip	:	86314-9464
Country	:	US
Telephone Number	:	928-830-2410
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2022
Last Update Date	:	01/27/2026

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