Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | TRN17416 | FL |
NPI | 1003178880 |
---|---|
Provider Name | Lindsay Marie Podhajsky |
First Address | Daytona Beach, FL 32114-2724 |
Second Address | Daytona Beach, FL 32114-2724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2012 |
Last Update Date | 27/02/2013 |