Provider Demographics
NPI:1477795094
Name:DUNST, DIANE MELISSA (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:MELISSA
Last Name:DUNST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DIANE
Other - Middle Name:MELISSA
Other - Last Name:BELVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:150 EAST SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757
Mailing Address - Country:US
Mailing Address - Phone:631-225-7200
Mailing Address - Fax:631-225-9550
Practice Address - Street 1:150 EAST SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757
Practice Address - Country:US
Practice Address - Phone:631-225-7200
Practice Address - Fax:631-225-9550
Is Sole Proprietor?:No
Enumeration Date:2009-03-27
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2708452085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400131502Medicare UPIN