Provider Demographics
NPI:1568545770
Name:DINKIN, ROXANE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROXANE
Middle Name:
Last Name:DINKIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9215 12TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-8303
Mailing Address - Country:US
Mailing Address - Phone:941-920-7445
Mailing Address - Fax:
Practice Address - Street 1:9215 12TH AVE NW
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-8303
Practice Address - Country:US
Practice Address - Phone:941-920-7445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6474103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE7581Medicare ID - Type Unspecified