Healthcare Provider Details

I. General information

NPI: 1104740349
Provider Name (Legal Business Name): ASHLYN DONN MUNDY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13535 CUMBERLAND RD
FISHERS IN
46038-3602
US

IV. Provider business mailing address

14284 BALD EAGLE DR APT 205
NOBLESVILLE IN
46060-8705
US

V. Phone/Fax

Practice location:
  • Phone: 574-343-6151
  • Fax:
Mailing address:
  • Phone: 574-343-6151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number000064847
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: