| Dna Center Llc | |
|
1430 Mason Ave Daytona Beach FL 32117-4551 | |
| (386) 274-2000 | |
| (386) 274-2009 |
| Full Name | Dna Center Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1430 Mason Ave, Daytona Beach, Florida |
| Authorized Official Name and Position | Sudhir Rao (CEO) |
| Authorized Official Contact | 7323095384 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dna Center Llc 1430 Mason Ave Daytona Beach FL 32117-4551 Ph: (386) 274-3601 | Dna Center Llc 1430 Mason Ave Daytona Beach FL 32117-4551 Ph: (386) 274-2000 |
| NPI Number | 1609117647 |
|---|---|
| Provider Enumeration Date | 03/14/2013 |
| Last Update Date | 09/20/2024 |
| Medicare PECOS PAC ID | 7618108978 |
|---|---|
| Medicare Enrollment ID | O20140331000084 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609117647 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | John J Sassano |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1164410650 PECOS PAC ID: 1557326477 Enrollment ID: I20041119000674 |
| Provider Name | Robert W Sessoms |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1053366765 PECOS PAC ID: 3678582376 Enrollment ID: I20060407000131 |
| Provider Name | Michel Van Thielen |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1841200144 PECOS PAC ID: 5991988636 Enrollment ID: I20110317000887 |
| Provider Name | Christy Davis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518925973 PECOS PAC ID: 0749204527 Enrollment ID: I20120426000291 |
| Provider Name | Elizabeth C Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437408812 PECOS PAC ID: 4688815558 Enrollment ID: I20130719000237 |
| Provider Name | Lynn Howard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053767921 PECOS PAC ID: 1153606041 Enrollment ID: I20170315001589 |
| Provider Name | Jennifer Zerrudo Traverso |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699294496 PECOS PAC ID: 8426316498 Enrollment ID: I20171220002093 |
| Provider Name | Michael Lagoe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730698044 PECOS PAC ID: 3173884780 Enrollment ID: I20180222001420 |
| Provider Name | Padma Puppala |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1518456870 PECOS PAC ID: 2264776376 Enrollment ID: I20181130000461 |
| Provider Name | Richard Mitchel Fuentes |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1154595528 PECOS PAC ID: 7012255128 Enrollment ID: I20190215001046 |
| Provider Name | Ekaterina Grant |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770163644 PECOS PAC ID: 4688079817 Enrollment ID: I20210825002985 |
| Provider Name | Francisco Orlando Perez |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1801922455 PECOS PAC ID: 5294131207 Enrollment ID: I20210831000324 |
| Provider Name | Loren E Gomes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972277622 PECOS PAC ID: 4385041052 Enrollment ID: I20210922002565 |
| Provider Name | Sudhir R Rao |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1629103759 PECOS PAC ID: 6608965223 Enrollment ID: I20220609001669 |
| Provider Name | Suhas Badarinath |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1821133323 PECOS PAC ID: 7214008804 Enrollment ID: I20220611000182 |
| Provider Name | Coreen Kelly |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790319994 PECOS PAC ID: 4082090238 Enrollment ID: I20220926003034 |
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