Healthcare Provider Details

I. General information

NPI: 1831028687
Provider Name (Legal Business Name): D'ANDRE HARRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8001 BEATY GROVE DR
TAMPA FL
33626-1602
US

IV. Provider business mailing address

10538 AZALEA DR
PORT RICHEY FL
34668-2813
US

V. Phone/Fax

Practice location:
  • Phone: 813-926-5454
  • Fax:
Mailing address:
  • Phone: 813-531-2685
  • Fax: 813-531-2685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberH620-172-01-371-0
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: