Provider Demographics
NPI:1083805659
Name:MACDONALD, SIERRA B (AUD)
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:B
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38135 MARKET SQ
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-7505
Mailing Address - Country:US
Mailing Address - Phone:813-907-9992
Mailing Address - Fax:813-355-5034
Practice Address - Street 1:2352 BRUCE B DOWNS BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-9203
Practice Address - Country:US
Practice Address - Phone:813-907-9992
Practice Address - Fax:813-355-5034
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1529231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAY1529OtherLICENSE NUMBER