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General NPI Number Information
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NPI Number | 1952046591
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Entity Type | Individual
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Provider Name | AMANDA JILL DONLON
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Gender | Female
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Dates
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Enumeration Date | 04/28/2022
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Last Update Date | 04/28/2022
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Provider Practice Location Address
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Address Line | 1 STADIUM ROAD STUDENT HEALTH SERVICES 2ND FL
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City | STONY BROOK
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State | NY
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Zip | 11794-2518
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Country | US
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Telephone | 631-632-6720
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Fax |
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Provider Business Mailing Address
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Address Line | 21339 40TH AVE
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City | BAYSIDE
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State | NY
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Zip | 11361-2046
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Country | US
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Telephone | 607-661-7799
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 023292
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License Number State | NY
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