Provider Demographics
NPI:1205801784
Name:CHAYKIN-GLOVER, DANA B (DO)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:B
Last Name:CHAYKIN-GLOVER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:DANA
Other - Middle Name:B
Other - Last Name:CHAYKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 863407
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-3407
Mailing Address - Country:US
Mailing Address - Phone:941-917-2600
Mailing Address - Fax:941-917-7884
Practice Address - Street 1:842 SUNSET LAKE BLVD
Practice Address - Street 2:401
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-7551
Practice Address - Country:US
Practice Address - Phone:941-497-8220
Practice Address - Fax:941-497-8239
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7113207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00279129OtherRAILROAD MEDICARE
FL57254OtherBCBS
FL274927100Medicaid
FL57254OtherBCBS
FL57254YMedicare PIN