Healthcare Provider Details

I. General information

NPI: 1821917162
Provider Name (Legal Business Name): MARISSA ANDREOU DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2026
Last Update Date: 07/11/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 PALM BAY RD NE UNIT 107
WEST MELBOURNE FL
32904-9201
US

IV. Provider business mailing address

2361 WILLET PL APT 3216
MELBOURNE FL
32940-3632
US

V. Phone/Fax

Practice location:
  • Phone: 321-410-8622
  • Fax:
Mailing address:
  • Phone: 586-623-9606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN32196
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: