Healthcare Provider Details

I. General information

NPI: 1235122565
Provider Name (Legal Business Name): ANDREW STUART BRAUNSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 03/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 E ALTAMONTE DR SUITE 216
ALTAMONTE SPRINGS FL
32701-5102
US

IV. Provider business mailing address

661 E ALTAMONTE DR SUITE 216
ALTAMONTE SPRINGS FL
32701-5102
US

V. Phone/Fax

Practice location:
  • Phone: 407-339-4324
  • Fax: 407-339-3843
Mailing address:
  • Phone: 407-339-4324
  • Fax: 407-339-3843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0046852
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: