Provider Demographics
NPI:1447950993
Name:RAFAILOVITC, DAHIANA (PMHNP)
Entity type:Individual
Prefix:
First Name:DAHIANA
Middle Name:
Last Name:RAFAILOVITC
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 N OLIVE AVE APT 627
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-5574
Mailing Address - Country:US
Mailing Address - Phone:561-800-8405
Mailing Address - Fax:
Practice Address - Street 1:290 N OLIVE AVE APT 627
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-5574
Practice Address - Country:US
Practice Address - Phone:561-800-8405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-03
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11025039363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health