Basic Information
| Provider Information | |||||||||
| NPI: | 1346253424 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANDRADE | ||||||||
| FirstName: | YENY | ||||||||
| MiddleName: | WALESKA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1735 E HWY 50 STE B | ||||||||
| Address2: | |||||||||
| City: | CLERMONT | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347115189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522410549 | ||||||||
| FaxNumber: | 3522429325 | ||||||||
| Practice Location | |||||||||
| Address1: | 1735 E HWY 50 STE B | ||||||||
| Address2: | |||||||||
| City: | CLERMONT | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347115189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522410549 | ||||||||
| FaxNumber: | 3522429325 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2006 | ||||||||
| LastUpdateDate: | 11/24/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 11/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME95577 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 276363000 | 05 | FL | MEDICAID |