Provider Demographics
NPI:1023553997
Name:CHETIN, ANDRIY
Entity Type:Individual
Prefix:
First Name:ANDRIY
Middle Name:
Last Name:CHETIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 W PRINCETON ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804
Mailing Address - Country:US
Mailing Address - Phone:407-936-4238
Mailing Address - Fax:
Practice Address - Street 1:710 W PRINCETON ST
Practice Address - Street 2:SUITE A
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-5214
Practice Address - Country:US
Practice Address - Phone:407-936-4128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-30
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3700171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist