MEDICARE: DR. ANDREW MICHAEL GELLADY M.D.

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	208000000X	Pediatrics Physician	ME0026499	FL

General Provider Information

NPI Number	:	1750374732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW MICHAEL GELLADY M.D.

Provider Business Mailing Address
First Line	:	4738 GRAND BLVD
Second Line	:	SUITE C
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-5170
Country	:	US
Telephone Number	:	727-807-7800
Fax Number	:	727-807-7878

Provider Business Practice Location Address
First Line	:	4738 GRAND BLVD
Second Line	:	SUITE C
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-5170
Country	:	US
Telephone Number	:	727-807-7800
Fax Number	:	727-807-7878

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

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	10/04/2011

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