Provider Demographics
NPI:1790645752
Name:LACHIUSA, ANDREA B
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:B
Last Name:LACHIUSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 BRIDGEVIEW TER
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-7937
Mailing Address - Country:US
Mailing Address - Phone:954-703-0457
Mailing Address - Fax:
Practice Address - Street 1:413 BRIDGEVIEW TER
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-7937
Practice Address - Country:US
Practice Address - Phone:954-703-0457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-13
Last Update Date:2025-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND5595133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered