Provider Demographics
NPI:1972508562
Name:DE ANDRADE, ANTONIO C (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:C
Last Name:DE ANDRADE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 HESTIA LOOP APT 538
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9569
Mailing Address - Country:US
Mailing Address - Phone:407-921-9953
Mailing Address - Fax:
Practice Address - Street 1:480 W CENTRAL PKWY
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2415
Practice Address - Country:US
Practice Address - Phone:407-683-0808
Practice Address - Fax:407-379-0511
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1013612086H0002X
TXG0687207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Yes2086H0002XAllopathic & Osteopathic PhysiciansSurgeryHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX841510Medicare ID - Type UnspecifiedMEDICARE
TXC12858Medicare UPIN