Provider Demographics
NPI:1124098504
Name:MILLER, D'LANE SALLY (PHD)
Entity type:Individual
Prefix:DR
First Name:D'LANE
Middle Name:SALLY
Last Name:MILLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 BARATARIA LN
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-3698
Mailing Address - Country:US
Mailing Address - Phone:850-243-8086
Mailing Address - Fax:850-243-2702
Practice Address - Street 1:404 BARATARIA LN
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-3698
Practice Address - Country:US
Practice Address - Phone:850-243-8086
Practice Address - Fax:850-243-2702
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2024-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY00003359103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59-3736816OtherGROUP TAX ID
FL75407OtherBCBS
7944548OtherAETNA
FL59-3736816OtherGROUP TAX ID