Provider Demographics
NPI:1861804874
Name:SCANNELL, ANDREA (MSED, CLC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:SCANNELL
Suffix:
Gender:F
Credentials:MSED, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 30TH DR
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-3252
Mailing Address - Country:US
Mailing Address - Phone:917-514-5244
Mailing Address - Fax:
Practice Address - Street 1:2330 30TH DR
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-3252
Practice Address - Country:US
Practice Address - Phone:917-514-5244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-24
Last Update Date:2014-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALPP-78321OtherALPP ACADEMY OF LACTATION POLICY AND PRACTICE, INC.