Healthcare Provider Details

I. General information

NPI: 1033022470
Provider Name (Legal Business Name): VICTORIA ELENA ANDALUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VICTORIA ELENA WEBSTER

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 DAIRY RD
WEST MELBOURNE FL
32904-4046
US

IV. Provider business mailing address

914 ANTIGO WAY APT 3302
MELBOURNE FL
32904-5229
US

V. Phone/Fax

Practice location:
  • Phone: 917-723-5008
  • Fax:
Mailing address:
  • Phone: 917-723-5008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: