Healthcare Provider Details

I. General information

NPI: 1285214122
Provider Name (Legal Business Name): HANH JENNIE DANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2542 INDIGO DR
DUNEDIN FL
34698-6519
US

IV. Provider business mailing address

2542 INDIGO DR
DUNEDIN FL
34698-6519
US

V. Phone/Fax

Practice location:
  • Phone: 727-453-1476
  • Fax:
Mailing address:
  • Phone: 727-453-1476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133005036
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: