Healthcare Provider Details

I. General information

NPI: 1447323266
Provider Name (Legal Business Name): PRITHA DHUNGANA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 02/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 OAKLEY SEAVER DRIVE BLDG J
CLERMONT FL
34711
US

IV. Provider business mailing address

2397 E COUNTY ROAD 466 OXFORD
OXFORD FL
34484-3317
US

V. Phone/Fax

Practice location:
  • Phone: 352-330-2020
  • Fax: 352-330-2020
Mailing address:
  • Phone: 352-330-2020
  • Fax: 352-360-6582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME 93964
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: