Healthcare Provider Details

I. General information

NPI: 1467566992
Provider Name (Legal Business Name): DONNA CHERYL GELLMAN-RODRIGUEZ PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4240 LAKELAND HIGHLANDS RD
LAKELAND FL
33813-3113
US

IV. Provider business mailing address

1140 COUNTRY OAKS LN
LAKELAND FL
33810-8117
US

V. Phone/Fax

Practice location:
  • Phone: 863-398-5813
  • Fax: 863-683-6164
Mailing address:
  • Phone: 863-398-5813
  • Fax: 863-683-6164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY5562
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: