Healthcare Provider Details

I. General information

NPI: 1265989016
Provider Name (Legal Business Name): ANDREA LYNN SVOBODA NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2016
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1053 BELMONT AVE
YOUNGSTOWN OH
44504-1007
US

IV. Provider business mailing address

1053 BELMONT AVE
YOUNGSTOWN OH
44504-1007
US

V. Phone/Fax

Practice location:
  • Phone: 330-480-7350
  • Fax: 330-746-7436
Mailing address:
  • Phone: 330-480-7350
  • Fax: 330-746-7436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.019843
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberAPRN.CNP.019843
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: