Provider Demographics
NPI:1235533381
Name:ANDRE, WEEDNY
Entity Type:Individual
Prefix:MR
First Name:WEEDNY
Middle Name:
Last Name:ANDRE
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 1:460 NE 178TH ST
Mailing Address - Street 2:223
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-1918
Mailing Address - Country:US
Mailing Address - Phone:305-610-4017
Mailing Address - Fax:305-764-2971
Practice Address - Street 1:460 NE 178TH ST
Practice Address - Street 2:223
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-1918
Practice Address - Country:US
Practice Address - Phone:305-610-4017
Practice Address - Fax:305-760-2971
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH11726103K00000X
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst