Provider Demographics
NPI:1285225607
Name:DASS, NALINI GHISIAWAN (IBCLC, RCIS, RCES)
Entity Type:Individual
Prefix:MRS
First Name:NALINI
Middle Name:GHISIAWAN
Last Name:DASS
Suffix:
Gender:F
Credentials:IBCLC, RCIS, RCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 SUN CITY CENTER PLAZA
Mailing Address - Street 2:#6013
Mailing Address - City:SUN CITY CENTER
Mailing Address - State:FL
Mailing Address - Zip Code:33573
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5209 LAKE SIENA DR
Practice Address - Street 2:
Practice Address - City:WIMAUMA
Practice Address - State:FL
Practice Address - Zip Code:33598-4439
Practice Address - Country:US
Practice Address - Phone:941-307-9374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-301407174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN