Healthcare Provider Details

I. General information

NPI: 1306870530
Provider Name (Legal Business Name): DANA L BROUSSARD PERRY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8946 CONROY WINDERMERE RD
ORLANDO FL
32835-3128
US

IV. Provider business mailing address

2660 W FAIRBANKS AVE
WINTER PARK FL
32789-3385
US

V. Phone/Fax

Practice location:
  • Phone: 407-876-1009
  • Fax: 407-876-6742
Mailing address:
  • Phone: 407-898-2767
  • Fax: 407-898-9443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License NumberME68693
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberME68693
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberME68693
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: