Healthcare Provider Details

I. General information

NPI: 1093806655
Provider Name (Legal Business Name): DINA DAHAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10967 LAKE UNDERHILL RD SUITE 148
ORLANDO FL
32825-4457
US

IV. Provider business mailing address

10967 LAKE UNDERHILL RD SUITE 148
ORLANDO FL
32825-4457
US

V. Phone/Fax

Practice location:
  • Phone: 407-208-0708
  • Fax: 407-208-0709
Mailing address:
  • Phone: 407-208-0708
  • Fax: 407-208-0709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME89651
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberME89651
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: