Healthcare Provider Details

I. General information

NPI: 1467386540
Provider Name (Legal Business Name): ANDREA BALLESTEROS PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22417 PANTHER RUN CT
LAND O LAKES FL
34639-2910
US

IV. Provider business mailing address

22417 PANTHER RUN CT
LAND O LAKES FL
34639-2910
US

V. Phone/Fax

Practice location:
  • Phone: 813-629-0337
  • Fax: 813-629-0337
Mailing address:
  • Phone: 813-629-0337
  • Fax: 813-629-0337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY9389
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: