Provider Demographics
NPI:1467103341
Name:CONRAD, DANA
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:CONRAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 SUMMER CLUB DR APT 213
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-7117
Mailing Address - Country:US
Mailing Address - Phone:321-604-1381
Mailing Address - Fax:
Practice Address - Street 1:1909 SUMMER CLUB DR APT 213
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-7117
Practice Address - Country:US
Practice Address - Phone:321-604-1381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician