Provider Demographics
NPI:1427892777
Name:ANDREU, RANDY DAVID
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:DAVID
Last Name:ANDREU
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 1:9360 FONTAINEBLEAU BLVD APT 611
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-5618
Mailing Address - Country:US
Mailing Address - Phone:786-769-9991
Mailing Address - Fax:
Practice Address - Street 1:9310 FONTAINEBLEAU BLVD APT 309
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-4252
Practice Address - Country:US
Practice Address - Phone:786-769-9991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-21
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLA536724034700106E00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst