Healthcare Provider Details

I. General information

NPI: 1891650164
Provider Name (Legal Business Name): ANDREA STANBURY-MORIAH NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4829 NW 48TH TER
TAMARAC FL
33319-3627
US

IV. Provider business mailing address

4829 NW 48TH TER
TAMARAC FL
33319-3627
US

V. Phone/Fax

Practice location:
  • Phone: 954-854-5105
  • Fax:
Mailing address:
  • Phone: 954-854-5105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberF09250856
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: