Provider Demographics
NPI:1811144355
Name:DUNAYCZAN, WALTER (LMT)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:
Last Name:DUNAYCZAN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4630 SUNRISE BLVD
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-1234
Mailing Address - Country:US
Mailing Address - Phone:561-601-6464
Mailing Address - Fax:
Practice Address - Street 1:15200 JOG RD
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-1247
Practice Address - Country:US
Practice Address - Phone:561-601-6464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA344447174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist