Provider Demographics
NPI:1740575489
Name:DAKSIAN, VERONICA (PA)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:DAKSIAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7380 SW 107TH AVE UNIT 1111
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-2795
Mailing Address - Country:US
Mailing Address - Phone:786-537-9100
Mailing Address - Fax:
Practice Address - Street 1:7000 W 12TH AVE STE 21
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-5170
Practice Address - Country:US
Practice Address - Phone:305-362-5516
Practice Address - Fax:305-362-5516
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA-9105580363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1740575489OtherFLORIDA MEDICARE