MEDICARE: DR. DUSTIN N LY MD

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	207R00000X	Internal Medicine Physician	ME114777	FL

General Provider Information

NPI Number	:	1710195268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DUSTIN N LY MD

Provider Business Mailing Address
First Line	:	4737 OLD CANOE CREEK RD
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34769-1400
Country	:	US
Telephone Number	:	407-705-3222
Fax Number	:

Provider Business Practice Location Address
First Line	:	4737 OLD CANOE CREEK RD
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34769-1400
Country	:	US
Telephone Number	:	407-705-3222
Fax Number	:

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

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	01/02/2014

Similar Medicare Providers

1811949415 — CARMEN ANA SIERRA M.D.
Practice Location Address:

4741 OLD CANOE CREEK RD
SAINT CLOUD, FL
34769-1400

Practice Phone: 321-805-4787
Practice Fax:

1164579132 — DR. STEVEN LEE PETTY D.C.
Practice Location Address:

4797 OLD CANOE CREEK RD
SAINT CLOUD, FL
34769-1400

Practice Phone: 407-498-0222
Practice Fax: 407-892-0800

1861544835 — DR. BRETT ELIZABETH PETTY D.C.
Practice Location Address:

4797 OLD CANOE CREEK RD
SAINT CLOUD, FL
34769-1400

Practice Phone: 407-498-0222
Practice Fax: 407-892-0800

1063533438 — JOINT MANEUVERS CHIROPRACTIC CENTRE PA
Practice Location Address:

4797 OLD CANOE CREEK RD
SAINT CLOUD, FL
34769-1400

Practice Phone: 407-498-0222
Practice Fax: 407-892-0800

1386835601 — DR. NAGA LAKSHMANA PRASAD NIDADAVOLU M.D
Practice Location Address:

4745 OLD CANOE CREEK RD
SAINT CLOUD, FL
34769-1400

Practice Phone: 407-818-1664
Practice Fax: 407-818-1654

1902138217 — MS. REKHA NIDADAVOLU PHYSICIAN ASSISTANT
Practice Location Address:

4745 OLD CANOE CREEK RD
SAINT CLOUD, FL
34769-1400

Practice Phone: 305-905-9316
Practice Fax:

Directions to “ DR. DUSTIN N LY MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.