Healthcare Provider Details

I. General information

NPI: 1871406645
Provider Name (Legal Business Name): DUSTIN DELAIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 E PARK AVE STE 1A
TALLAHASSEE FL
32301-3446
US

IV. Provider business mailing address

2935 WOODRICH DR APT C
TALLAHASSEE FL
32301-3689
US

V. Phone/Fax

Practice location:
  • Phone: 386-235-3179
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: