Provider Demographics
NPI:1154133718
Name:BASTA, ANDREW YOUNAN
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:YOUNAN
Last Name:BASTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 WEDGEFIELD CT
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-4336
Mailing Address - Country:US
Mailing Address - Phone:757-214-2024
Mailing Address - Fax:
Practice Address - Street 1:841 WEDGEFIELD CT
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4336
Practice Address - Country:US
Practice Address - Phone:757-214-2024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter