Provider Demographics
NPI:1427261189
Name:SYWULAK, ANDREA E (PHD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:E
Last Name:SYWULAK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 JAYMOR ROAD
Mailing Address - Street 2:SUITE A 120
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966
Mailing Address - Country:US
Mailing Address - Phone:215-355-8812
Mailing Address - Fax:215-355-0926
Practice Address - Street 1:928 JAYMOR ROAD
Practice Address - Street 2:SUITE A 120
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966
Practice Address - Country:US
Practice Address - Phone:215-355-8812
Practice Address - Fax:215-355-0926
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003501L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1295890846OtherNPI SYWULAK & WEISS PSYCH
PA4616180OtherAETNA
PA428178Medicare ID - Type UnspecifiedINDV PIN
PA060452Medicare PIN