Provider Demographics
NPI:1366125874
Name:VARGAS, ANDREA ELISE
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:ELISE
Last Name:VARGAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 ST ELIAS DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-2879
Mailing Address - Country:US
Mailing Address - Phone:980-621-5090
Mailing Address - Fax:
Practice Address - Street 1:2320 REDBRIDGE LN
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-2495
Practice Address - Country:US
Practice Address - Phone:919-925-4923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist