Provider Demographics
NPI:1629373519
Name:ABANISHE, DAHOMEY (PHD)
Entity Type:Individual
Prefix:
First Name:DAHOMEY
Middle Name:
Last Name:ABANISHE
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 1:4343 NEWBERRY RD STE 14
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-2826
Mailing Address - Country:US
Mailing Address - Phone:352-224-2200
Mailing Address - Fax:352-224-2484
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-6036
Practice Address - Country:US
Practice Address - Phone:352-265-0294
Practice Address - Fax:352-265-0096
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-24
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8868103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105454700Medicaid