Healthcare Provider Details

I. General information

NPI: 1578589198
Provider Name (Legal Business Name): DALIA FULOP MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 09/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 MIRROR LAKE DR STE A
ORMOND BEACH FL
32174-3101
US

IV. Provider business mailing address

8 MIRROR LAKE DR STE A
ORMOND BEACH FL
32174-3101
US

V. Phone/Fax

Practice location:
  • Phone: 386-673-2500
  • Fax: 386-673-3204
Mailing address:
  • Phone: 386-673-2500
  • Fax: 386-673-3204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME94973
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084D0003X
TaxonomyDiagnostic Neuroimaging (Psychiatry & Neurology) Physician
License NumberME094973
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: