Provider Demographics
NPI:1225891153
Name:ANDUEZA, IVY
Entity Type:Individual
Prefix:
First Name:IVY
Middle Name:
Last Name:ANDUEZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 NW 27TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-3012
Mailing Address - Country:US
Mailing Address - Phone:786-431-1133
Mailing Address - Fax:786-431-1287
Practice Address - Street 1:757 NW 27TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3012
Practice Address - Country:US
Practice Address - Phone:786-431-1133
Practice Address - Fax:786-431-1287
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-02
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ11850235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist