Provider Demographics
NPI:1194120410
Name:ANDONI, ANISA (PA-C)
Entity type:Individual
Prefix:
First Name:ANISA
Middle Name:
Last Name:ANDONI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 ALAFAYA WOODS BLVD
Mailing Address - Street 2:STE 1000
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6212
Mailing Address - Country:US
Mailing Address - Phone:407-542-7335
Mailing Address - Fax:
Practice Address - Street 1:220 ALAFAYA WOODS BLVD
Practice Address - Street 2:STE 1000
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6212
Practice Address - Country:US
Practice Address - Phone:407-542-7335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-29
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9108352363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical