Provider Demographics
NPI:1306431218
Name:DIGIANDOMENICO, DAVID (PA-C)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:DIGIANDOMENICO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:382 PALM DR
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9532
Mailing Address - Country:US
Mailing Address - Phone:954-243-4239
Mailing Address - Fax:
Practice Address - Street 1:443 W COUNTY ROAD 419 STE 1041
Practice Address - Street 2:
Practice Address - City:CHULUOTA
Practice Address - State:FL
Practice Address - Zip Code:32766-9520
Practice Address - Country:US
Practice Address - Phone:407-366-2890
Practice Address - Fax:407-542-1012
Is Sole Proprietor?:No
Enumeration Date:2021-03-02
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9114085207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine