Provider Demographics
NPI:1538963954
Name:JOSEPH, ANDELY
Entity type:Individual
Prefix:DR
First Name:ANDELY
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11288 ROYAL PALM BLVD APT 88
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-6833
Mailing Address - Country:US
Mailing Address - Phone:954-557-8139
Mailing Address - Fax:
Practice Address - Street 1:11288 ROYAL PALM BLVD APT 88
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-6833
Practice Address - Country:US
Practice Address - Phone:954-557-8139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRPA-2500363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant