Individual
MS. ANDREA LEIGH VANDAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3201 MEDICAL WAY, SUITE 101, SEBRING, FL 33870-5412
(863) 382-0770
(863) 471-9968
Mailing address
3201 MEDICAL WAY, SUITE 101, SEBRING, FL 33870-5412
(863) 382-0770
(863) 471-9968
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9106204
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004133400
—
FL
01
—
PAX00009111
PRESCRIBING LICENSE
FL
Enumeration date
10/10/2011
Last updated
12/12/2011
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