MEDICARE: ANDRE MINOTT

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1750701025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDRE MINOTT

Provider Business Mailing Address
First Line	:	4023 MARINA ISLE DR
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34746-1835
Country	:	US
Telephone Number	:	305-321-4848
Fax Number	:

Provider Business Practice Location Address
First Line	:	155 CRANES ROOST BLVD
Second Line	:	SUITE 2090
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-3468
Country	:	US
Telephone Number	:	305-321-4848
Fax Number	:

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

Provider Enumeration Date	:	04/24/2014
Last Update Date	:	04/24/2014

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Directions to “ ANDRE MINOTT ” Practice Location

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