Healthcare Provider Details

I. General information

NPI: 1811359508
Provider Name (Legal Business Name): ANDREA MARCELA MADIEDO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7765 SW 87TH AVE STE 212
MIAMI FL
33173-2586
US

IV. Provider business mailing address

80 GARDNER ST APT 31
ALLSTON MA
02134-2243
US

V. Phone/Fax

Practice location:
  • Phone: 305-596-3080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberME156548
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: