Healthcare Provider Details

I. General information

NPI: 1134876311
Provider Name (Legal Business Name): DAVID DOUGLAS DUANY MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2022
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 CONROY WINDERMERE RD STE 203
ORLANDO FL
32835-2688
US

IV. Provider business mailing address

8106 TIBET BUTLER DR
WINDERMERE FL
34786-5612
US

V. Phone/Fax

Practice location:
  • Phone: 407-704-1461
  • Fax:
Mailing address:
  • Phone: 407-748-2710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number19900
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: