# DALE P GREYSLAK PA PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174945521
- **Authorized official:** MR. DALE PHILLIP GREYSLAK PAC (MANAGING MEMBER)
- **Authorized official phone:** (407) 451-0192

## Contact information

- **Practice address:** 3491 TITANIC CIR, INDIALANTIC, FL 32903-1871
- **Practice address phone:** (407) 451-0192
- **Mailing address:** PO BOX 410185, MELBOURNE, FL 32941-0185
- **Mailing address phone:** (407) 451-0192

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363AS0400X | Surgical Physician Assistant | PA9104508 | FL | Yes |

## Other

- **Enumeration date:** 01/19/2014
- **Last updated:** 12/13/2023