Healthcare Provider Details

I. General information

NPI: 1649893660
Provider Name (Legal Business Name): STACYANN ANDAYA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2020
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2637 SHADELANDS DR
WALNUT CREEK CA
94598-2512
US

IV. Provider business mailing address

2637 SHADELANDS DR
WALNUT CREEK CA
94598-2512
US

V. Phone/Fax

Practice location:
  • Phone: 925-932-6330
  • Fax: 925-932-0139
Mailing address:
  • Phone: 925-932-6330
  • Fax: 925-932-0139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95014595
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: