Healthcare Provider Details

I. General information

NPI: 1750374732
Provider Name (Legal Business Name): ANDREW MICHAEL GELLADY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 10/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4738 GRAND BLVD SUITE C
NEW PORT RICHEY FL
34652-5170
US

IV. Provider business mailing address

4738 GRAND BLVD SUITE C
NEW PORT RICHEY FL
34652-5170
US

V. Phone/Fax

Practice location:
  • Phone: 727-807-7800
  • Fax: 727-807-7878
Mailing address:
  • Phone: 727-807-7800
  • Fax: 727-807-7878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0026499
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: