Andrea Gail Spader, MEDICAL AESTHETICIAN

Primary specialty

SpecialistTaxonomy code 174400000X

License

FB9722504 Issued in FL

Practice address

1606 NE Miami Gardens Dr
N Miami Beach, FL 33179-4900

Phone

(305) 354-8266

Fax

(305) 354-8280

NPI assigned

Dec 20, 2010

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1292803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1332374400000",
    "number": "1255634895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1606 NE MIAMI GARDENS DR",
            "city": "N MIAMI BEACH",
            "state": "FL",
            "postal_code": "331794900",
            "telephone_number": "305-354-8266",
            "fax_number": "305-354-8280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1606 NE MIAMI GARDENS DR",
            "city": "N MIAMI BEACH",
            "state": "FL",
            "postal_code": "331794900",
            "telephone_number": "305-354-8266",
            "fax_number": "305-354-8280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPADER",
        "first_name": "ANDREA",
        "middle_name": "GAIL",
        "name_prefix": "Mrs.",
        "credential": "MEDICAL AESTHETICIAN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-12-20",
        "last_updated": "2012-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "FL",
            "license": "FB9722504",
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "FL",
            "license": "FB93013",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "FL",
            "license": "MA50604",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "FL",
            "license": "MA60818",
            "primary": false
        },
        {
            "code": "247200000X",
            "taxonomy_group": "",
            "desc": "Technician, Other",
            "state": "FL",
            "license": "EO1620",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in N Miami Beach, FL
• Providers in N Miami Beach, FL by specialty
• Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.