Healthcare Provider Details

I. General information

NPI: 1093019093
Provider Name (Legal Business Name): DAVANAND DOODNAUTH,M.D., PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2011
Last Update Date: 07/08/2021
Certification Date: 07/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 MONARCH ST STE 300
LEXINGTON KY
40513-1877
US

IV. Provider business mailing address

PO BOX 911014
LEXINGTON KY
40591-1014
US

V. Phone/Fax

Practice location:
  • Phone: 859-286-9951
  • Fax: 859-286-9952
Mailing address:
  • Phone: 859-523-0732
  • Fax: 859-523-1946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number40574
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVANAND DOODANUTH
Title or Position: PRESIDENT
Credential: MD
Phone: 859-523-0732