Provider Demographics
NPI:1063755155
Name:SCHWAN, ANDREA K
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:K
Last Name:SCHWAN
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 1:132 ARLO RD
Mailing Address - Street 2:APT 2B
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-3805
Mailing Address - Country:US
Mailing Address - Phone:718-801-3050
Mailing Address - Fax:
Practice Address - Street 1:132 ARLO RD
Practice Address - Street 2:APT 2B
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-3805
Practice Address - Country:US
Practice Address - Phone:718-801-3050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY638131121252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency