Provider Demographics
NPI:1902372121
Name:WALSH, ANDREW LAWRENCE (AP ACUPUNCTURE)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:LAWRENCE
Last Name:WALSH
Suffix:
Gender:M
Credentials:AP ACUPUNCTURE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 FRONTAGE ROAD
Mailing Address - Street 2:SUITE H
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-2581
Mailing Address - Country:US
Mailing Address - Phone:352-234-3011
Mailing Address - Fax:352-608-9344
Practice Address - Street 1:221 FRONTAGE ROAD
Practice Address - Street 2:SUITE H
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2581
Practice Address - Country:US
Practice Address - Phone:352-234-3011
Practice Address - Fax:352-608-9344
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-15
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3693171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty