Healthcare Provider Details

I. General information

NPI: 1356483218
Provider Name (Legal Business Name): FELIX N DUNKWU PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 11/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3661 S BABCOCK ST FL 2
MELBOURNE FL
32901-8205
US

IV. Provider business mailing address

3300 S FISKE BLVD
ROCKLEDGE FL
32955-4306
US

V. Phone/Fax

Practice location:
  • Phone: 321-434-7611
  • Fax: 321-727-3738
Mailing address:
  • Phone: 321-434-1981
  • Fax: 321-951-7408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9106921
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: