MEDICARE: MICHELE MCDONOUGH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Q00000X	Developmental Therapist		FL

General Provider Information

NPI Number	:	1679199277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELE MCDONOUGH

Provider Business Mailing Address
First Line	:	5185 DUNDEE AVE
Second Line	:
City	:	DE LEON SPRINGS
State	:	FL
Zip	:	32130-3457
Country	:	US
Telephone Number	:	727-698-6564
Fax Number	:

Provider Business Practice Location Address
First Line	:	5185 DUNDEE AVE
Second Line	:
City	:	DE LEON SPRINGS
State	:	FL
Zip	:	32130-3457
Country	:	US
Telephone Number	:	727-698-6564
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2020
Last Update Date	:	06/03/2026

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Directions to “ MICHELE MCDONOUGH ” Practice Location

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