Healthcare Provider Details

I. General information

NPI: 1790133270
Provider Name (Legal Business Name): DONNA YETTO ITDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DONNA M PEASLEE

II. Dates (important events)

Enumeration Date: 05/25/2016
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5825 LANATE AVE
NEW PORT RICHEY FL
34652-4737
US

IV. Provider business mailing address

5825 LANATE AVE
NEW PORT RICHEY FL
34652-4737
US

V. Phone/Fax

Practice location:
  • Phone: 727-277-2395
  • Fax: 727-213-6246
Mailing address:
  • Phone: 727-277-2395
  • Fax: 727-213-6246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: