Healthcare Provider Details

I. General information

NPI: 1447833033
Provider Name (Legal Business Name): MELISSA MARIE D'ANDREA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2021
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MARYS AVE STE 3
KINGSTON NY
12401-5896
US

IV. Provider business mailing address

111 MARYS AVE STE 3
KINGSTON NY
12401-5896
US

V. Phone/Fax

Practice location:
  • Phone: 845-339-3663
  • Fax:
Mailing address:
  • Phone: 845-339-3663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number343894
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: