Provider Demographics
NPI:1619795143
Name:DORADO NICO, ANDRES MANUEL (PA)
Entity type:Individual
Prefix:
First Name:ANDRES
Middle Name:MANUEL
Last Name:DORADO NICO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6340 SW 149TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-2796
Mailing Address - Country:US
Mailing Address - Phone:786-412-5731
Mailing Address - Fax:305-274-5320
Practice Address - Street 1:974 OLD DIXIE HWY STE A
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4933
Practice Address - Country:US
Practice Address - Phone:305-845-1655
Practice Address - Fax:305-845-1641
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-02
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-392034106S00000X
PR2305363AM0700X
FLPACN72363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty