Healthcare Provider Details

I. General information

NPI: 1629608195
Provider Name (Legal Business Name): DONALD SHAWN DOTSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2020
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17670 NW 78TH AVE
HIALEAH FL
33015-3664
US

IV. Provider business mailing address

17670 NW 78TH AVE
HIALEAH FL
33015
US

V. Phone/Fax

Practice location:
  • Phone: 305-826-6755
  • Fax: 305-826-6770
Mailing address:
  • Phone: 305-826-6755
  • Fax: 305-826-6770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS3072
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: