Provider Demographics
NPI:1033743620
Name:FERNANDO, DANA
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:FERNANDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 CONCH KEY WAY
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-5219
Mailing Address - Country:US
Mailing Address - Phone:321-696-5071
Mailing Address - Fax:
Practice Address - Street 1:2705 REBECCA LN STE B
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8336
Practice Address - Country:US
Practice Address - Phone:407-260-0551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist