Provider Demographics
NPI:1407016017
Name:MCDONNELL, BRENDA R (AUD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:R
Last Name:MCDONNELL
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 1:1907 CAPITAL CIR NE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4421
Mailing Address - Country:US
Mailing Address - Phone:850-222-4434
Mailing Address - Fax:850-222-4434
Practice Address - Street 1:1907 CAPITAL CIR NE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4421
Practice Address - Country:US
Practice Address - Phone:850-222-4434
Practice Address - Fax:850-222-4434
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1039A231H00000X, 231HA2400X, 231HA2500X, 237600000X
FLAY863231H00000X, 231HA2400X, 231HA2500X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000825500Medicaid
FLAM004ZMedicare PIN