Provider Demographics
NPI:1861663973
Name:ANDERS, AIDA L (PSYD)
Entity Type:Individual
Prefix:
First Name:AIDA
Middle Name:L
Last Name:ANDERS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 SHERIDAN ST STE 98
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-8802
Mailing Address - Country:US
Mailing Address - Phone:954-632-2409
Mailing Address - Fax:954-538-0075
Practice Address - Street 1:9000 SHERIDAN ST STE 98
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-8802
Practice Address - Country:US
Practice Address - Phone:954-632-2409
Practice Address - Fax:954-538-0075
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-17
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6410103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL768431200Medicaid
FL768431200Medicaid