Healthcare Provider Details

I. General information

NPI: 1518483353
Provider Name (Legal Business Name): ANDREA SARAH ORVIETO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 E HALLANDALE BEACH BLVD
HALLANDALE BEACH FL
33009-4488
US

IV. Provider business mailing address

2030 N 29TH AVE APT 102
HOLLYWOOD FL
33020-1735
US

V. Phone/Fax

Practice location:
  • Phone: 305-967-8976
  • Fax:
Mailing address:
  • Phone: 305-588-5526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number3814
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: