Provider Demographics
NPI:1124801675
Name:DHANA, RAYNE (MD, MBA)
Entity type:Individual
Prefix:DR
First Name:RAYNE
Middle Name:
Last Name:DHANA
Suffix:
Gender:F
Credentials:MD, MBA
Other - Prefix:DR
Other - First Name:CANDICE
Other - Middle Name:SHERELLE
Other - Last Name:BLACKNALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MBA
Mailing Address - Street 1:300 GEORGE ST STE 901
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-6662
Mailing Address - Country:US
Mailing Address - Phone:203-785-2095
Mailing Address - Fax:
Practice Address - Street 1:300 GEORGE ST STE 901
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-6662
Practice Address - Country:US
Practice Address - Phone:203-785-2095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-17
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101Y00000XBehavioral Health & Social Service ProvidersCounselor