Healthcare Provider Details

I. General information

NPI: 1528285749
Provider Name (Legal Business Name): COMPREHENSIVE NEUROLOGY CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 09/17/2013
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 Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DINA DAHAN
Title or Position: OWNER
Credential: MD
Phone: 407-208-0708