Healthcare Provider Details

I. General information

NPI: 1578424743
Provider Name (Legal Business Name): ANDREA ISELA LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2025
Last Update Date: 11/18/2025
Certification Date: 11/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1406 NW 208TH ST
MIAMI GARDENS FL
33169-2244
US

IV. Provider business mailing address

1406 NW 208TH ST
MIAMI GARDENS FL
33169-2244
US

V. Phone/Fax

Practice location:
  • Phone: 786-368-9718
  • Fax:
Mailing address:
  • Phone: 786-368-9718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number11043771
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number11043771
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: