Healthcare Provider Details

I. General information

NPI: 1801721428
Provider Name (Legal Business Name): MAVIS-ALICIA ANDREWS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 N GANNON AVE
STATEN ISLAND NY
10314-4317
US

IV. Provider business mailing address

535 N GANNON AVE
STATEN ISLAND NY
10314-4317
US

V. Phone/Fax

Practice location:
  • Phone: 983-215-6950
  • Fax:
Mailing address:
  • Phone: 983-215-6950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: