Healthcare Provider Details

I. General information

NPI: 1043091994
Provider Name (Legal Business Name): DYLAN MICHAEL ALLEN MSPH, CGC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2023
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6535 NEMOURS PKWY
ORLANDO FL
32827-7884
US

IV. Provider business mailing address

1025 OASIS MEWS DR UNIT 6403
ORLANDO FL
32807-8462
US

V. Phone/Fax

Practice location:
  • Phone: 407-650-7715
  • Fax: 407-650-7133
Mailing address:
  • Phone: 727-642-6609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: