Provider Demographics
NPI:1730448135
Name:ANSAS LLC
Entity type:Organization
Organization Name:ANSAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDUJAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-905-8531
Mailing Address - Street 1:1401 SE GOLDTREE DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7584
Mailing Address - Country:US
Mailing Address - Phone:772-905-8531
Mailing Address - Fax:
Practice Address - Street 1:1401 SE GOLDTREE DR
Practice Address - Street 2:SUITE 104
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7584
Practice Address - Country:US
Practice Address - Phone:772-905-8531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-07
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME804872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty