Healthcare Provider Details

I. General information

NPI: 1558139071
Provider Name (Legal Business Name): NATASHA DUMENIGO PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2023
Last Update Date: 12/14/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8875 NW 23RD ST
DORAL FL
33172-2419
US

IV. Provider business mailing address

8875 NW 23RD ST
DORAL FL
33172-2419
US

V. Phone/Fax

Practice location:
  • Phone: 305-653-5155
  • Fax:
Mailing address:
  • Phone: 305-653-5155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY-11910
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: