MEDICARE: IDATUDE MERDELUS DUMAY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor		FL

General Provider Information

NPI Number	:	1376416008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IDATUDE MERDELUS DUMAY

Provider Business Mailing Address
First Line	:	3395 NW 37TH AVE
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33309-5326
Country	:	US
Telephone Number	:	954-245-1639
Fax Number	:

Provider Business Practice Location Address
First Line	:	3395 NW 37TH AVE
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33309-5326
Country	:	US
Telephone Number	:	954-245-1639
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2025
Last Update Date	:	09/29/2025

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Directions to “ IDATUDE MERDELUS DUMAY ” Practice Location

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