Provider Demographics
NPI:1114513827
Name:BANDERAS ECHEVERRY, WALDYR MAURICIO (MD)
Entity Type:Individual
Prefix:
First Name:WALDYR
Middle Name:MAURICIO
Last Name:BANDERAS ECHEVERRY
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 1:3101 JODHPURS LN APT 2603
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-4858
Mailing Address - Country:US
Mailing Address - Phone:786-878-2913
Mailing Address - Fax:
Practice Address - Street 1:3101 JODHPURS LN APT 2603
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-4858
Practice Address - Country:US
Practice Address - Phone:786-878-2913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJDCATEM-037064208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice