Healthcare Provider Details

I. General information

NPI: 1538436969
Provider Name (Legal Business Name): MS. ELIZABETH LYNNE MCDONALD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2011
Last Update Date: 11/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 SINGLE DR
NORTH SYRACUSE NY
13212-2132
US

IV. Provider business mailing address

205 S MAIN ST
NORTH SYRACUSE NY
13212-3105
US

V. Phone/Fax

Practice location:
  • Phone: 315-458-9477
  • Fax:
Mailing address:
  • Phone: 315-218-2200
  • Fax: 315-218-2285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2284-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: