Provider Demographics
NPI:1578860102
Name:HEYDUK, DOMINIKA
Entity Type:Individual
Prefix:MRS
First Name:DOMINIKA
Middle Name:
Last Name:HEYDUK
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 1:16607 KINGLETRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-3938
Mailing Address - Country:US
Mailing Address - Phone:813-774-2031
Mailing Address - Fax:
Practice Address - Street 1:1308 W SLIGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-5902
Practice Address - Country:US
Practice Address - Phone:813-375-3980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist