Provider Demographics
NPI:1720430788
Name:DE SOUZA E MELO, ANDRE (MD)
Entity type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:
Last Name:DE SOUZA E MELO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8131 LAKEWOOD MAIN ST STE 205
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-5060
Mailing Address - Country:US
Mailing Address - Phone:941-359-9546
Mailing Address - Fax:941-344-0621
Practice Address - Street 1:8131 LAKEWOOD MAIN ST STE 205
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-5060
Practice Address - Country:US
Practice Address - Phone:941-359-9546
Practice Address - Fax:941-344-0621
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-01
Last Update Date:2025-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME162083207R00000X
NMMD2019-0460207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine