Provider Demographics
NPI:1245410448
Name:DONATUCCI, ASHLEY NICOLLE (PA)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:NICOLLE
Last Name:DONATUCCI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:NICOLLE
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:525 E 68TH ST # 98
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-4870
Mailing Address - Country:US
Mailing Address - Phone:212-746-5330
Mailing Address - Fax:212-746-8720
Practice Address - Street 1:525 E 68TH ST # 98
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-4870
Practice Address - Country:US
Practice Address - Phone:212-746-5330
Practice Address - Fax:212-746-8720
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY23-013059363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant