MEDICARE: MS. ANDREA MARLENE WRIGHT MSED

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	1206671	NY

General Provider Information

NPI Number	:	1962793901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANDREA MARLENE WRIGHT MSED

Provider Business Mailing Address
First Line	:	1038 UNION ST
Second Line	:	1A
City	:	BROOKLYN
State	:	NY
Zip	:	11225-1283
Country	:	US
Telephone Number	:	718-221-5145
Fax Number	:	718-221-5145

Provider Business Practice Location Address
First Line	:	1038 UNION ST
Second Line	:	1A
City	:	BROOKLYN
State	:	NY
Zip	:	11225-1283
Country	:	US
Telephone Number	:	718-221-5145
Fax Number	:	718-221-5145

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

Provider Enumeration Date	:	04/25/2011
Last Update Date	:	04/25/2011

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