MEDICARE: MISS ANDREA SCANDAGLIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	188984327	NY

General Provider Information

NPI Number	:	1376944991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ANDREA SCANDAGLIA

Provider Business Mailing Address
First Line	:	2025 RICHMOND AVE
Second Line	:	SUITE 200
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3937
Country	:	US
Telephone Number	:	800-314-8078
Fax Number	:	718-228-4226

Provider Business Practice Location Address
First Line	:	62 SEIDMAN AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-5025
Country	:	US
Telephone Number	:	347-217-2250
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2014
Last Update Date	:	11/12/2014

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Directions to “ MISS ANDREA SCANDAGLIA ” Practice Location

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