Provider Demographics
NPI:1356654511
Name:FABIANI, DANA SUZANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:SUZANNE
Last Name:FABIANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DANA
Other - Middle Name:SUZANNE
Other - Last Name:LEFKOWITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5573 MARQUESAS CIR UNIT 9B
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-3332
Mailing Address - Country:US
Mailing Address - Phone:440-463-3975
Mailing Address - Fax:941-922-4264
Practice Address - Street 1:5573 MARQUESAS CIR UNIT 9B
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-3332
Practice Address - Country:US
Practice Address - Phone:941-922-4264
Practice Address - Fax:941-922-4265
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-16
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME105776207Q00000X
FLME 105776207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003994500Medicaid
FLP01010957OtherMEDICARE RAILROAD PROVIDER NUMBER
FLEO619XMedicare PIN