Provider Demographics
NPI:1467535617
Name:DELL, DIANA LYNN (MD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNN
Last Name:DELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 531078
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33747-1078
Mailing Address - Country:US
Mailing Address - Phone:919-624-6548
Mailing Address - Fax:
Practice Address - Street 1:50 N LAURA ST STE 2500
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32202-3646
Practice Address - Country:US
Practice Address - Phone:855-247-1940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2019-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.0166012084P0800X
FLBD01370232084P0800X
FLME1262122084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2185673AMedicare ID - Type Unspecified
D04175Medicare ID - Type Unspecified
NC8928236Medicare ID - Type Unspecified