=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407202039
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DONNA L DONATI PSYD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2016
-----------------------------------------------------
Last Update Date | 05/18/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2533 PERMIT PL
-----------------------------------------------------
City | NEW PORT RICHEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34655-4519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-421-5329
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 649 HEATHERWOOD CT
-----------------------------------------------------
City | TARPON SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34688-7283
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-421-5329
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DONNA LYNN DONATI-WADDELL
-----------------------------------------------------
Credential | PSY.D.
-----------------------------------------------------
Telephone | 727-421-5329
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------