Healthcare Provider Details

I. General information

NPI: 1902097397
Provider Name (Legal Business Name): PAJA LEE DONNELLY CNS NP IN PSYCHIATRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 08/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 21 244 ST WINCHESTER CONSULTATION
DOUGLASTON NY
11362-1913
US

IV. Provider business mailing address

71-21 244 ST WINCHESTER CONSULTATION CENTER
DOUGLASTON NY
11362-1913
US

V. Phone/Fax

Practice location:
  • Phone: 718-224-9193
  • Fax:
Mailing address:
  • Phone: 718-224-9193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2195251
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF400512
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number0108674
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: