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NPI Code Detail

MEDICARE: ANDRA IRINA MANFREDO VIEIRA

MEDICARE: ANDRA IRINA MANFREDO VIEIRA
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
1106S00000XBehavior TechnicianRBT-23-256897PA

General Provider Information

NPI Number : 1629761184
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDRA IRINA MANFREDO VIEIRA
Provider Business Mailing Address
First Line : 640 FREEDOM BUSINESS CTR DR STE 220
Second Line :
City : KING OF PRUSSIA
State : PA
Zip : 19406-1376
Country : US
Telephone Number : 484-393-4107
Fax Number : 484-231-8631
Provider Business Practice Location Address
First Line : 1 IRON BRIDGE DR STE 100
Second Line :
City : COLLEGEVILLE
State : PA
Zip : 19426-2059
Country : US
Telephone Number : 484-393-4107
Fax Number : 484-231-8631
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2023
Last Update Date : 05/31/2023

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Directions to “ ANDRA IRINA MANFREDO VIEIRA ” Practice Location

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