1356654511 NPI number — DR. DANA SUZANNE FABIANI M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356654511 NPI number — DR. DANA SUZANNE FABIANI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FABIANI
Provider First Name:
DANA
Provider Middle Name:
SUZANNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEFKOWITZ
Provider Other First Name:
DANA
Provider Other Middle Name:
SUZANNE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356654511
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/29/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5573 MARQUESAS CIR UNIT 9B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SARASOTA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34233-3332
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-463-3975
Provider Business Mailing Address Fax Number:
941-922-4264

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5573 MARQUESAS CIR UNIT 9B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SARASOTA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34233-3332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-922-4264
Provider Business Practice Location Address Fax Number:
941-922-4265
Provider Enumeration Date:
07/16/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  ME105776 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: ME 105776 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 003994500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01010957 . This is a "MEDICARE RAILROAD PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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