Provider Demographics
NPI:1891185716
Name:ANDREW D.CONTI, M.D. PA
Entity Type:Organization
Organization Name:ANDREW D.CONTI, M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-789-1272
Mailing Address - Street 1:1400 N US HIGHWAY 441 STE 912
Mailing Address - Street 2:ATTN: YVETTE
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32159-6811
Mailing Address - Country:US
Mailing Address - Phone:352-789-1272
Mailing Address - Fax:
Practice Address - Street 1:1400 N US HIGHWAY 441 STE 912
Practice Address - Street 2:ATTN: YVETTE
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32159-6811
Practice Address - Country:US
Practice Address - Phone:352-789-1272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-30
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254963800Medicaid
FL254963800Medicaid