Provider Demographics
NPI:1972641546
Name:DESANTIS, ANDREA MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:MARIE
Last Name:DESANTIS
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 1:411 MANVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10570-2826
Mailing Address - Country:US
Mailing Address - Phone:617-233-5263
Mailing Address - Fax:
Practice Address - Street 1:526 WARBURTON AVE
Practice Address - Street 2:APT #3
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701
Practice Address - Country:US
Practice Address - Phone:617-923-4410
Practice Address - Fax:617-923-0468
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA117932251P0200X
NYNY018217103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics