=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588530489
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN-ANDREW KAMBANIS DCEM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2025
-----------------------------------------------------
Last Update Date | 10/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2916 SUGAR BEAR TRL
-----------------------------------------------------
City | PALM HARBOR
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34684-1733
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-835-0944
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3905 TAMPA RD UNIT 2564
-----------------------------------------------------
City | OLDSMAR
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34677-9605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-835-0944
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP1600X
-----------------------------------------------------
Taxonomy Name | Pastoral Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------