Provider Demographics
NPI:1902102486
Name:DREW, ABBY (LAC)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:
Last Name:DREW
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4385 RECREATION DR
Mailing Address - Street 2:NUMBER 128
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-2232
Mailing Address - Country:US
Mailing Address - Phone:585-394-5954
Mailing Address - Fax:
Practice Address - Street 1:4385 RECREATION DR
Practice Address - Street 2:NUMBER 128
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-2232
Practice Address - Country:US
Practice Address - Phone:585-394-5954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-01
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003702171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist