Healthcare Provider Details

I. General information

NPI: 1821358839
Provider Name (Legal Business Name): ANDREA MITHAI AVONDSTONDT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2012
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 COLUMBIA ST STE 100
ORLANDO FL
32806-1133
US

IV. Provider business mailing address

21 COLUMBIA ST STE 100
ORLANDO FL
32806-1133
US

V. Phone/Fax

Practice location:
  • Phone: 321-842-4810
  • Fax: 321-842-4809
Mailing address:
  • Phone: 321-842-4810
  • Fax: 321-842-4809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME144716
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberP27666
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberME144716
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: