Provider Demographics
NPI:1508229352
Name:FERRERAS, ANDY
Entity Type:Individual
Prefix:
First Name:ANDY
Middle Name:
Last Name:FERRERAS
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 1:116 POWELL BLVD
Mailing Address - Street 2:#5307
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-8138
Mailing Address - Country:US
Mailing Address - Phone:407-504-3231
Mailing Address - Fax:
Practice Address - Street 1:1133 W STATE ROAD 436
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2745
Practice Address - Country:US
Practice Address - Phone:407-504-3231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver