Provider Demographics
NPI:1821358839
Name:AVONDSTONDT, ANDREA MITHAI (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:MITHAI
Last Name:AVONDSTONDT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 NW PEACOCK BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2222
Mailing Address - Country:US
Mailing Address - Phone:772-878-6599
Mailing Address - Fax:772-871-2905
Practice Address - Street 1:293 NW PEACOCK BLVD STE 202
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-2222
Practice Address - Country:US
Practice Address - Phone:772-878-6599
Practice Address - Fax:772-871-2905
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME144716207V00000X, 207VF0040X
MDP27666207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1821358839Medicaid