Healthcare Provider Details

I. General information

NPI: 1659504702
Provider Name (Legal Business Name): DONNA M SLATTERY GENZALE R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2009
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 FARNER PL
THE VILLAGES FL
32163-6066
US

IV. Provider business mailing address

1020 LAKE SUMTER LNDG
THE VILLAGES FL
32162-2699
US

V. Phone/Fax

Practice location:
  • Phone: 844-884-9355
  • Fax: 352-674-8910
Mailing address:
  • Phone: 352-674-8905
  • Fax: 352-674-8901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND12325
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: