Healthcare Provider Details

I. General information

NPI: 1043273337
Provider Name (Legal Business Name): ADITI I DAGLI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2006
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 W GORE ST
ORLANDO FL
32806-1141
US

IV. Provider business mailing address

60 W GORE ST
ORLANDO FL
32806-1141
US

V. Phone/Fax

Practice location:
  • Phone: 407-648-7802
  • Fax: 321-841-3709
Mailing address:
  • Phone: 407-648-7802
  • Fax: 321-841-3709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME 92521
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License NumberME92521
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: