Provider Demographics
NPI:1174850549
Name:DAWKINS, DEVON MALCOLM
Entity Type:Individual
Prefix:MR
First Name:DEVON
Middle Name:MALCOLM
Last Name:DAWKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 AVENUE K
Mailing Address - Street 2:3F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-4370
Mailing Address - Country:US
Mailing Address - Phone:347-267-4469
Mailing Address - Fax:
Practice Address - Street 1:1302 AVENUE K
Practice Address - Street 2:3F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-4370
Practice Address - Country:US
Practice Address - Phone:347-267-4469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25380252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency