=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487180147
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELIZA ANDRZEJCZYK
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2017
-----------------------------------------------------
Last Update Date | 06/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 40555 CLAY GULLY RD
-----------------------------------------------------
City | MYAKKA CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34251-5930
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-735-3258
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5220 LEVI LN
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34233-5224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-735-3258
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 25366
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------