Provider Demographics
NPI:1598066110
Name:DEVITO, DANA BLAIR (MD)
Entity Type:Individual
Prefix:MISS
First Name:DANA
Middle Name:BLAIR
Last Name:DEVITO
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 1:520 E 72ND ST
Mailing Address - Street 2:APARTMENT #16D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4849
Mailing Address - Country:US
Mailing Address - Phone:917-922-6106
Mailing Address - Fax:
Practice Address - Street 1:520 E 72ND ST
Practice Address - Street 2:APARTMENT #16D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4849
Practice Address - Country:US
Practice Address - Phone:917-922-6106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2590902084P0800X
CT0481992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry