Provider Demographics
NPI:1992480800
Name:DAHDUL, DINA ALEXANDRA
Entity type:Individual
Prefix:
First Name:DINA
Middle Name:ALEXANDRA
Last Name:DAHDUL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 BELLA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-3073
Mailing Address - Country:US
Mailing Address - Phone:413-301-4479
Mailing Address - Fax:
Practice Address - Street 1:9 BELLA VISTA DR
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-3073
Practice Address - Country:US
Practice Address - Phone:413-301-4479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
CAPA63112363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant