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General NPI Number Information
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NPI Number | 1588704407
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Entity Type | Individual
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Provider Name | MAURA ANDRONIC MD
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Gender | Female
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 10/22/2019
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Provider Practice Location Address
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Address Line | 1000 MAR WALT DR
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-6708
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Country | US
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Telephone | 850-729-9343
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Fax | 855-373-3605
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Provider Business Mailing Address
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Address Line | 1000 MAR WALT DR
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-6708
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Country | US
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Telephone | 850-729-9343
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Fax | 855-373-3605
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 35078267
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME142925
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License Number State | FL
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