Provider Demographics
NPI:1639468531
Name:DALTON AYOUNG, JOANNA N (MD)
Entity Type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:N
Last Name:DALTON AYOUNG
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 1:1890 W COUNTY ROAD 419 STE 2010
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-4402
Mailing Address - Country:US
Mailing Address - Phone:407-635-3600
Mailing Address - Fax:321-842-3901
Practice Address - Street 1:1890 W COUNTY ROAD 419 STE 2010
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-4402
Practice Address - Country:US
Practice Address - Phone:407-635-3600
Practice Address - Fax:321-842-3901
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271059207V00000X
FLME151383207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY271059OtherNYS MEDICAL LICENSE
FLME151383OtherFL MEDICAL LICENSE
NY04533900Medicaid
FL111608800Medicaid