Provider Demographics
NPI:1255908703
Name:DE OLIVEIRA, ANDREA CRISTINA (MA)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:CRISTINA
Last Name:DE OLIVEIRA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6735 CONROY RD STE 202
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-3571
Mailing Address - Country:US
Mailing Address - Phone:407-844-5055
Mailing Address - Fax:
Practice Address - Street 1:6735 CONROY RD STE 202
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-3571
Practice Address - Country:US
Practice Address - Phone:407-844-5055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA77305225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL77305OtherSTATE OF FLORIDA DEPARTMENT OF HEALTH - MASSAGE THERAPIST LICENSE