Healthcare Provider Details

I. General information

NPI: 1114855418
Provider Name (Legal Business Name): ANDREW VADEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 STANFORD DR
CORAL GABLES FL
33146-2065
US

IV. Provider business mailing address

2912 WEYMOUTH DR
RICHMOND VA
23235-2260
US

V. Phone/Fax

Practice location:
  • Phone: 305-284-2211
  • Fax:
Mailing address:
  • Phone: 804-627-1491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRN9656214
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: