Healthcare Provider Details

I. General information

NPI: 1104449685
Provider Name (Legal Business Name): DIAMONT DINA MANDOWSKY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2020
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14951 ROYAL OAKS LN APT 1403
NORTH MIAMI FL
33181-2479
US

IV. Provider business mailing address

14951 ROYAL OAKS LN APT 1403
NORTH MIAMI FL
33181-2479
US

V. Phone/Fax

Practice location:
  • Phone: 305-469-9653
  • Fax:
Mailing address:
  • Phone: 305-469-9653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: