MEDICARE: DR. DONNA A MCDONALD PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PY0004842	FL

General Provider Information

NPI Number	:	1043201130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONNA A MCDONALD PSYD

Provider Business Mailing Address
First Line	:	1111 CRANDON BLVD
Second Line	:	C1105
City	:	KEY BISCAYNE
State	:	FL
Zip	:	33149-2745
Country	:	US
Telephone Number	:	305-361-9467
Fax Number	:	305-361-7401

Provider Business Practice Location Address
First Line	:	2000 S DIXIE HWY
Second Line	:	103
City	:	MIAMI
State	:	FL
Zip	:	33133-2456
Country	:	US
Telephone Number	:	305-670-6011
Fax Number	:	305-361-7401

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2005
Last Update Date	:	07/08/2007

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