| NPI | 1891159596 |
|---|---|
| Former Name | ANDREA LEIGH DEDONATO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 63741) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 238113450) | |
| Enumeration Date | 2016-04-08 |
| Last Update Date | 2021-07-06 |