Provider Demographics
NPI:1033146303
Name:ANDUJAR, NEY F (MD)
Entity Type:Individual
Prefix:DR
First Name:NEY
Middle Name:F
Last Name:ANDUJAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 SE GOLDTREE DR STE 104
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7584
Mailing Address - Country:US
Mailing Address - Phone:772-905-8531
Mailing Address - Fax:772-905-8526
Practice Address - Street 1:1401 SE GOLDTREE DRIVE, STE 104
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952
Practice Address - Country:UM
Practice Address - Phone:772-905-8531
Practice Address - Fax:772-905-8526
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80487174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265334600Medicaid
FLH03544Medicare UPIN
FL265334600Medicaid