Provider Demographics
NPI:1346095619
Name:DUNNELL, MARQASE
Entity Type:Individual
Prefix:
First Name:MARQASE
Middle Name:
Last Name:DUNNELL
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 1:4242 SPOLETO CIR APT 300
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-5035
Mailing Address - Country:US
Mailing Address - Phone:904-450-0650
Mailing Address - Fax:
Practice Address - Street 1:4242 SPOLETO CIR APT 300
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-5035
Practice Address - Country:US
Practice Address - Phone:904-450-0650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-20
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer