Provider Demographics
NPI:1821593443
Name:DOSSANTOS, LUANA LILIAN DIAS
Entity Type:Individual
Prefix:
First Name:LUANA
Middle Name:LILIAN DIAS
Last Name:DOSSANTOS
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 1:9 ROBINSON AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-5516
Mailing Address - Country:US
Mailing Address - Phone:203-589-6283
Mailing Address - Fax:
Practice Address - Street 1:9 ROBINSON AVE FL 2
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5516
Practice Address - Country:US
Practice Address - Phone:203-589-6283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health