Provider Demographics
NPI:1093300923
Name:DYNAMIC HEALTH ALLIANCE
Entity Type:Organization
Organization Name:DYNAMIC HEALTH ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SIDERIS
Authorized Official - Middle Name:S
Authorized Official - Last Name:LOGOTHETIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-491-5691
Mailing Address - Street 1:4223 SIDERNO CT
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-9047
Mailing Address - Country:US
Mailing Address - Phone:850-491-5691
Mailing Address - Fax:
Practice Address - Street 1:4223 SIDERNO CT
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-9047
Practice Address - Country:US
Practice Address - Phone:850-491-5691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies