Healthcare Provider Details

I. General information

NPI: 1649668385
Provider Name (Legal Business Name): ANJALI VANDRIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2015
Last Update Date: 03/27/2022
Certification Date: 03/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 SW 4TH ST STE 6
CAPE CORAL FL
33991-1984
US

IV. Provider business mailing address

730 SW 4TH ST STE 6
CAPE CORAL FL
33991-1984
US

V. Phone/Fax

Practice location:
  • Phone: 239-910-0712
  • Fax: 855-237-3130
Mailing address:
  • Phone: 239-910-0712
  • Fax: 855-237-3130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: