Healthcare Provider Details

I. General information

NPI: 1043607518
Provider Name (Legal Business Name): ANDREW BENNETT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21301 POWERLINE RD STE 107
BOCA RATON FL
33433-2389
US

IV. Provider business mailing address

21301 POWERLINE RD STE 107
BOCA RATON FL
33433-2389
US

V. Phone/Fax

Practice location:
  • Phone: 866-228-7676
  • Fax:
Mailing address:
  • Phone: 561-961-0255
  • Fax: 561-231-7008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number144891
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number303753
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number303753
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number144891
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: