Healthcare Provider Details

I. General information

NPI: 1679199277
Provider Name (Legal Business Name): MICHELE MCDONOUGH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2020
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5185 DUNDEE AVE
DE LEON SPRINGS FL
32130-3457
US

IV. Provider business mailing address

5185 DUNDEE AVE
DE LEON SPRINGS FL
32130-3457
US

V. Phone/Fax

Practice location:
  • Phone: 727-698-6564
  • Fax:
Mailing address:
  • Phone: 727-698-6564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: