Provider Demographics
NPI:1316620149
Name:ZAWADZKY, ANDREA L (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:ZAWADZKY
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:114 HOOPER AVE
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-7606
Mailing Address - Country:US
Mailing Address - Phone:908-309-7200
Mailing Address - Fax:732-506-5328
Practice Address - Street 1:MODERN PSYCHIATRY
Practice Address - Street 2:20 HOSPITAL DRIVE, SUITE 4
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-0875
Practice Address - Country:US
Practice Address - Phone:732-831-6094
Practice Address - Fax:732-832-3632
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-09
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ14892600363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty