Provider Demographics
NPI:1275186553
Name:DALE, ANDREA CAMILE
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:CAMILE
Last Name:DALE
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 1:100 EINSTEIN LOOP APT 23F
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-4948
Mailing Address - Country:US
Mailing Address - Phone:917-736-5417
Mailing Address - Fax:929-222-4612
Practice Address - Street 1:100 EINSTEIN LOOP APT 23F
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-4948
Practice Address - Country:US
Practice Address - Phone:917-736-5417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY324826164W00000X
NY324826-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse