MEDICARE: ANDREA ANDRADE LDN, RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	ND9010	FL

General Provider Information

NPI Number	:	1558258228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA ANDRADE LDN, RD

Provider Business Mailing Address
First Line	:	24151 BEATRIX BLVD UNIT 905
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33954-3852
Country	:	US
Telephone Number	:	321-402-8735
Fax Number	:

Provider Business Practice Location Address
First Line	:	24151 BEATRIX BLVD UNIT 905
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33954-3852
Country	:	US
Telephone Number	:	321-402-8735
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2025
Last Update Date	:	06/23/2025

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