Provider Demographics
NPI:1558139071
Name:DUMENIGO, NATASHA (PSYD)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:DUMENIGO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8875 NW 23RD ST
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2419
Mailing Address - Country:US
Mailing Address - Phone:305-653-5155
Mailing Address - Fax:
Practice Address - Street 1:8875 NW 23RD ST
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-2419
Practice Address - Country:US
Practice Address - Phone:305-653-5155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY-11910103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist