Healthcare Provider Details

I. General information

NPI: 1487180147
Provider Name (Legal Business Name): ELIZA ANDRZEJCZYK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2017
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40555 CLAY GULLY RD
MYAKKA CITY FL
34251-5930
US

IV. Provider business mailing address

5220 LEVI LN
SARASOTA FL
34233-5224
US

V. Phone/Fax

Practice location:
  • Phone: 941-735-3258
  • Fax:
Mailing address:
  • Phone: 941-735-3258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number25366
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: