Healthcare Provider Details

I. General information

NPI: 1801857966
Provider Name (Legal Business Name): ASHISH DALAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 06/04/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8725 N WICKHAM RD
MELBOURNE FL
32940-2239
US

IV. Provider business mailing address

3300 S FISKE BLVD
ROCKLEDGE FL
32955-4306
US

V. Phone/Fax

Practice location:
  • Phone: 321-253-4673
  • Fax: 321-253-4338
Mailing address:
  • Phone: 321-268-4200
  • Fax: 321-268-1386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberME85152
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberME0085152
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberME85152
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: