Healthcare Provider Details

I. General information

NPI: 1346877818
Provider Name (Legal Business Name): ANDREW DAKKAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 WATERMAN WAY
TAVARES FL
32778-5266
US

IV. Provider business mailing address

2600 WESTHALL LN STE 4
MAITLAND FL
32751-7102
US

V. Phone/Fax

Practice location:
  • Phone: 352-253-3333
  • Fax: 317-705-5047
Mailing address:
  • Phone: 407-200-2355
  • Fax: 407-200-4947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME152108
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: