Provider Demographics
NPI:1154640332
Name:MOORE, DAYNA CHERISE (MD)
Entity type:Individual
Prefix:
First Name:DAYNA
Middle Name:CHERISE
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 S PINE ISLAND RD STE 800
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3923
Mailing Address - Country:US
Mailing Address - Phone:813-471-4445
Mailing Address - Fax:813-343-5022
Practice Address - Street 1:12871 CITRUS PLAZA DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-3010
Practice Address - Country:US
Practice Address - Phone:813-471-4445
Practice Address - Fax:813-343-5022
Is Sole Proprietor?:No
Enumeration Date:2010-05-27
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME117095208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009408200Medicaid