Provider Demographics
NPI:1932213659
Name:MUSSELMAN, DOMINIQUE LILY (MD, MSCR)
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:LILY
Last Name:MUSSELMAN
Suffix:
Gender:F
Credentials:MD, MSCR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1695 NW 9TH AVENUE, RM 2506
Mailing Address - Street 2:UNIVERSITY OF MIAMI DEPARTMENT OF PSYCHIATRY
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-0001
Mailing Address - Country:US
Mailing Address - Phone:404-723-8361
Mailing Address - Fax:
Practice Address - Street 1:1695 NW 9TH AVENUE, RM 2506
Practice Address - Street 2:JACKSON MEMORIAL HOSPITAL, MENTAL HEALTH HOSPITAL CENTE
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-0001
Practice Address - Country:US
Practice Address - Phone:404-723-8361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1082712084P0015X
GA336532084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA4662Medicare UPIN