Healthcare Provider Details

I. General information

NPI: 1497663595
Provider Name (Legal Business Name): ANDRE SAINT PATRICK EWAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 S UNIVERSITY DR
DAVIE FL
33328-2018
US

IV. Provider business mailing address

4962 PELICAN ST
COCONUT CREEK FL
33073-2426
US

V. Phone/Fax

Practice location:
  • Phone: 954-262-1300
  • Fax:
Mailing address:
  • Phone: 954-773-4632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: