Healthcare Provider Details

I. General information

NPI: 1811377989
Provider Name (Legal Business Name): LILIYA GANDRABUR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2015
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6280 SUNSET DR STE 501
SOUTH MIAMI FL
33143-4870
US

IV. Provider business mailing address

6280 SUNSET DR STE 501
SOUTH MIAMI FL
33143-4870
US

V. Phone/Fax

Practice location:
  • Phone: 305-671-3447
  • Fax: 305-671-3739
Mailing address:
  • Phone: 305-671-3447
  • Fax: 305-671-3739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number304657
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberME152470
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: