MEDICARE: ANDREA WAISBORD RDN

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	ND12457	FL

General Provider Information

NPI Number	:	1760370936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA WAISBORD RDN

Provider Business Mailing Address
First Line	:	525 NE 7TH ST APT 1814
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-3139
Country	:	US
Telephone Number	:	619-495-0801
Fax Number	:

Provider Business Practice Location Address
First Line	:	525 NE 7TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-3097
Country	:	US
Telephone Number	:	619-495-0801
Fax Number	:

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

Provider Enumeration Date	:	06/26/2025
Last Update Date	:	07/02/2025

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