Provider Demographics
NPI:1669164760
Name:HERNANDEZ PRADO, ANEDYS (MD)
Entity type:Individual
Prefix:
First Name:ANEDYS
Middle Name:
Last Name:HERNANDEZ PRADO
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 1:14254 DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:FL
Mailing Address - Zip Code:33527-4414
Mailing Address - Country:US
Mailing Address - Phone:813-349-7700
Mailing Address - Fax:
Practice Address - Street 1:14254 DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:FL
Practice Address - Zip Code:33527-4414
Practice Address - Country:US
Practice Address - Phone:813-349-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-25
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN1639208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty