Provider Demographics
NPI:1659090967
Name:SOARES, ANDREA (RD)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:
Last Name:SOARES
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:SOARES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:5652 NW 106TH AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-2811
Mailing Address - Country:US
Mailing Address - Phone:754-250-9168
Mailing Address - Fax:
Practice Address - Street 1:5652 NW 106TH AVE
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33076-2811
Practice Address - Country:US
Practice Address - Phone:754-250-9168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
927578133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty