Provider Demographics
NPI:1306638770
Name:ANDAYA, RUSSELLE ALCANTARA
Entity type:Individual
Prefix:
First Name:RUSSELLE
Middle Name:ALCANTARA
Last Name:ANDAYA
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 1:448 SHEFFORD DR
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-7946
Mailing Address - Country:US
Mailing Address - Phone:707-805-3889
Mailing Address - Fax:
Practice Address - Street 1:448 SHEFFORD DR
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-7946
Practice Address - Country:US
Practice Address - Phone:707-805-3889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-20
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95250790163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse