Healthcare Provider Details

I. General information

NPI: 1184328239
Provider Name (Legal Business Name): ANDREI SIMON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 WIREGRASS RANCH BLVD
WESLEY CHAPEL FL
33543-4274
US

IV. Provider business mailing address

10049 AVALON LAKE CIR
FORT MYERS FL
33913-2604
US

V. Phone/Fax

Practice location:
  • Phone: 813-388-4000
  • Fax:
Mailing address:
  • Phone: 971-533-9233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number23220
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: