Healthcare Provider Details

I. General information

NPI: 1871444265
Provider Name (Legal Business Name): ANDILOU LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 INDUSTRY RD STE 32
LEXINGTON KY
40505-3829
US

IV. Provider business mailing address

1020 INDUSTRY RD STE 32
LEXINGTON KY
40505-3829
US

V. Phone/Fax

Practice location:
  • Phone: 859-797-4304
  • Fax:
Mailing address:
  • Phone: 859-797-4304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ANDREE DEIFEL
Title or Position: OWNER
Credential: NP
Phone: 859-797-4304