Healthcare Provider Details

I. General information

NPI: 1457092736
Provider Name (Legal Business Name): ADENA ANDREA MAHADAI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2022
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 CORTEZ RD W
BRADENTON FL
34207-1335
US

IV. Provider business mailing address

2797 SHEARWATER ST
CLERMONT FL
34711-6275
US

V. Phone/Fax

Practice location:
  • Phone: 941-758-8818
  • Fax:
Mailing address:
  • Phone: 321-400-4164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO4681
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: