Provider Demographics
NPI:1447570635
Name:MACHADO, ANDREA (LMT, MMR)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:MACHADO
Suffix:
Gender:F
Credentials:LMT, MMR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 BELLEVUE ST NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-5533
Mailing Address - Country:US
Mailing Address - Phone:321-795-0519
Mailing Address - Fax:
Practice Address - Street 1:2815 W NEW HAVEN AVE STE 302
Practice Address - Street 2:
Practice Address - City:W MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-3655
Practice Address - Country:US
Practice Address - Phone:321-725-0073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL36407225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist