Provider Demographics
NPI:1912558214
Name:BALASIS, ANDREAS
Entity Type:Individual
Prefix:
First Name:ANDREAS
Middle Name:
Last Name:BALASIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2927 NETWORK PL APT 101A
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33559-2142
Mailing Address - Country:US
Mailing Address - Phone:631-942-0938
Mailing Address - Fax:
Practice Address - Street 1:26829 TANIC DR STE 101
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-4612
Practice Address - Country:US
Practice Address - Phone:813-517-6089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-27
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL115367900Medicaid