Provider Demographics
NPI:1255634895
Name:SPADER, ANDREA GAIL (MEDICAL AESTHETICIAN)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:GAIL
Last Name:SPADER
Suffix:
Gender:F
Credentials:MEDICAL AESTHETICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 NE MIAMI GARDENS DR
Mailing Address - Street 2:
Mailing Address - City:N MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-4900
Mailing Address - Country:US
Mailing Address - Phone:305-354-8266
Mailing Address - Fax:305-354-8280
Practice Address - Street 1:1606 NE MIAMI GARDENS DR
Practice Address - Street 2:
Practice Address - City:N MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179-4900
Practice Address - Country:US
Practice Address - Phone:305-354-8266
Practice Address - Fax:305-354-8280
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-20
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFB9722504174400000X
FLFB93013174400000X
FLMA50604174400000X
FLMA60818174400000X
FLEO1620247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other