Healthcare Provider Details

I. General information

NPI: 1568377497
Provider Name (Legal Business Name): ANDREA LUCIA MEYER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 NICOLLS RD
STONY BROOK NY
11794-0001
US

IV. Provider business mailing address

130 SOUNDVIEW RD
HUNTINGTON NY
11743-4109
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-6270
  • Fax:
Mailing address:
  • Phone: 520-909-4646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number036346
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: