Provider Demographics
NPI:1144778457
Name:DAU, KY (PA-C)
Entity Type:Individual
Prefix:
First Name:KY
Middle Name:
Last Name:DAU
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5332 VAN DYKE RD
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-4829
Mailing Address - Country:US
Mailing Address - Phone:813-960-1200
Mailing Address - Fax:813-441-7555
Practice Address - Street 1:5332 VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-4829
Practice Address - Country:US
Practice Address - Phone:813-960-1200
Practice Address - Fax:813-441-7555
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2019-05-08
Deactivation Date:2017-11-08
Deactivation Code:
Reactivation Date:2019-05-08
Provider Licenses
StateLicense IDTaxonomies
FLPA9109120363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant