# DR. ANDREA LILLY DIEVENDORF

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1225012800
- **Gender:** F
- **Credential:** DC

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | X0108561 | NY | Yes |

## Other

- **Enumeration date:** 12/06/2005
- **Last updated:** 08/25/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2601222001 | BSNENY | — |
| 01 | — | 7016671 | AETNA | — |
| 01 | — | NY23902 | MVP | — |