Provider Demographics
NPI:1760681118
Name:AZELVANDRE DO AND ASSOCIATES LLC
Entity Type:Organization
Organization Name:AZELVANDRE DO AND ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:AZELVANDRE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:407-339-1060
Mailing Address - Street 1:301 S MILWEE ST
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-4127
Mailing Address - Country:US
Mailing Address - Phone:407-339-1060
Mailing Address - Fax:407-339-1081
Practice Address - Street 1:301 S MILWEE ST
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4127
Practice Address - Country:US
Practice Address - Phone:407-339-1060
Practice Address - Fax:407-339-1081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAF670Medicare PIN