Healthcare Provider Details

I. General information

NPI: 1922344241
Provider Name (Legal Business Name): ASHTON DUDA HAJNOS P.A., A.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2012
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9330 STATE ROAD 54
TRINITY FL
34655-1808
US

IV. Provider business mailing address

18625 LE DAUPHINE PL
LUTZ FL
33558-2886
US

V. Phone/Fax

Practice location:
  • Phone: 727-834-4748
  • Fax:
Mailing address:
  • Phone: 716-471-6797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9106690
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number23016245
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: