Healthcare Provider Details

I. General information

NPI: 1972508562
Provider Name (Legal Business Name): ANTONIO C DE ANDRADE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 09/02/2022
Certification Date: 09/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 W CENTRAL PKWY
ALTAMONTE SPRINGS FL
32714-2415
US

IV. Provider business mailing address

2100 HESTIA LOOP APT 538
OVIEDO FL
32765-9569
US

V. Phone/Fax

Practice location:
  • Phone: 407-683-0808
  • Fax: 407-379-0511
Mailing address:
  • Phone: 407-921-9953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086H0002X
TaxonomyHospice and Palliative Medicine (Surgery) Physician
License NumberME101361
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: