Provider Demographics
NPI:1154640332
Name:MOORE, DAYNA C (MD)
Entity Type:Individual
Prefix:
First Name:DAYNA
Middle Name:C
Last Name:MOORE
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 1:900 S PINE ISLAND RD STE 800
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3923
Mailing Address - Country:US
Mailing Address - Phone:727-376-4040
Mailing Address - Fax:727-376-8824
Practice Address - Street 1:10710 STATE ROAD 54 STE 108
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-2263
Practice Address - Country:US
Practice Address - Phone:727-376-4040
Practice Address - Fax:727-376-8824
Is Sole Proprietor?:No
Enumeration Date:2010-05-27
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME117095208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009408200Medicaid