Healthcare Provider Details

I. General information

NPI: 1457086217
Provider Name (Legal Business Name): ANDREW YANICK BOYLE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2022
Last Update Date: 07/17/2022
Certification Date: 07/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11315 CORPORATE BLVD STE 105
ORLANDO FL
32817-8340
US

IV. Provider business mailing address

8238 VINELAND OAKS BLVD
ORLANDO FL
32835-8216
US

V. Phone/Fax

Practice location:
  • Phone: 407-534-0186
  • Fax:
Mailing address:
  • Phone: 407-534-2084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: