Provider Demographics
NPI:1942013743
Name:PROSTAK, DAWNA
Entity type:Individual
Prefix:
First Name:DAWNA
Middle Name:
Last Name:PROSTAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 N PARK AVE STE 212
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-3268
Mailing Address - Country:US
Mailing Address - Phone:407-539-0047
Mailing Address - Fax:
Practice Address - Street 1:505 N PARK AVE STE 212
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-3268
Practice Address - Country:US
Practice Address - Phone:407-539-0047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7194101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health