Provider Demographics
NPI:1093806655
Name:DAHAN, DINA (MD)
Entity Type:Individual
Prefix:
First Name:DINA
Middle Name:
Last Name:DAHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10967 LAKE UNDERHILL RD
Mailing Address - Street 2:SUITE 148
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-4457
Mailing Address - Country:US
Mailing Address - Phone:407-208-0708
Mailing Address - Fax:407-208-0709
Practice Address - Street 1:10967 LAKE UNDERHILL RD
Practice Address - Street 2:SUITE 148
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-4457
Practice Address - Country:US
Practice Address - Phone:407-208-0708
Practice Address - Fax:407-208-0709
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89651208000000X, 2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270472200Medicaid
FLI16707Medicare UPIN
FL37950AMedicare ID - Type Unspecified