Provider Demographics
NPI:1942230859
Name:DYSON, SENAIT (M D)
Entity Type:Individual
Prefix:
First Name:SENAIT
Middle Name:
Last Name:DYSON
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2141 N BEVERLY AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2155
Mailing Address - Country:US
Mailing Address - Phone:520-838-0777
Mailing Address - Fax:520-838-0669
Practice Address - Street 1:2141 N BEVERLY AVE
Practice Address - Street 2:STE 101
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2155
Practice Address - Country:US
Practice Address - Phone:520-838-0777
Practice Address - Fax:520-838-0669
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90945207N00000X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA86042AMedicare PIN