Provider Demographics
NPI:1538165444
Name:MASTANDREA, FRANK D (MD)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:D
Last Name:MASTANDREA
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 1:4710 N HABANA AVE
Mailing Address - Street 2:STE 400
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-7152
Mailing Address - Country:US
Mailing Address - Phone:813-875-8914
Mailing Address - Fax:813-872-7356
Practice Address - Street 1:4710 N HABANA AVE
Practice Address - Street 2:STE 400
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7152
Practice Address - Country:US
Practice Address - Phone:813-875-8914
Practice Address - Fax:813-872-7356
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2007-07-08
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-20
Provider Licenses
StateLicense IDTaxonomies
FLME0064045174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG24668Medicare UPIN