Provider Demographics
NPI:1164991923
Name:ACUPUNCTURE BY ANDREA, LLC
Entity Type:Organization
Organization Name:ACUPUNCTURE BY ANDREA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:VENUS
Authorized Official - Last Name:DANTI
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, LMT
Authorized Official - Phone:904-234-3964
Mailing Address - Street 1:13400 SUTTON PARK DR S STE 1603
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-0237
Mailing Address - Country:US
Mailing Address - Phone:904-234-3964
Mailing Address - Fax:
Practice Address - Street 1:13400 SUTTON PARK DR S STE 1603
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-0237
Practice Address - Country:US
Practice Address - Phone:904-234-3964
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-21
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3264OtherACUPUNCTURE LICENSE