Healthcare Provider Details

I. General information

NPI: 1457903460
Provider Name (Legal Business Name): ANDREA MARIE ESINHART
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2019
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6152 DELANCEY STATION ST STE 205
RIVERVIEW FL
33578-4206
US

IV. Provider business mailing address

6152 DELANCEY STATION ST STE 205
RIVERVIEW FL
33578-4206
US

V. Phone/Fax

Practice location:
  • Phone: 813-616-4004
  • Fax:
Mailing address:
  • Phone: 813-616-4004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA17240
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: