Provider Demographics
NPI:1144501156
Name:DAI, JAY
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:
Last Name:DAI
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:JIE
Other - Middle Name:
Other - Last Name:DAI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1102 ROSELING PL
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-4263
Mailing Address - Country:US
Mailing Address - Phone:863-202-0552
Mailing Address - Fax:
Practice Address - Street 1:1102 ROSELING PL
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-4263
Practice Address - Country:US
Practice Address - Phone:863-202-0552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43290183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist