Healthcare Provider Details

I. General information

NPI: 1609439561
Provider Name (Legal Business Name): ANDREW SPAEDY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 NW 2ND AVE STE 118
BOCA RATON FL
33431-6707
US

IV. Provider business mailing address

2701 NW 2ND AVE STE 118
BOCA RATON FL
33431-6707
US

V. Phone/Fax

Practice location:
  • Phone: 954-501-0054
  • Fax: 561-769-3598
Mailing address:
  • Phone: 561-556-8276
  • Fax: 561-769-3598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME167278
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME167278
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: