Provider Demographics
NPI:1942377031
Name:ZOTOVAS, ANDREA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:ZOTOVAS
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 1:400 STARLIGHT LN
Mailing Address - Street 2:
Mailing Address - City:JUNO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-2027
Mailing Address - Country:US
Mailing Address - Phone:561-319-3208
Mailing Address - Fax:561-627-3128
Practice Address - Street 1:715 SE 5TH ST
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2359
Practice Address - Country:US
Practice Address - Phone:772-221-9113
Practice Address - Fax:772-221-9115
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81304208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG55349Medicare UPIN