Provider Demographics
NPI:1407619240
Name:STATEN, VONDA ELIZABETH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:VONDA
Middle Name:ELIZABETH
Last Name:STATEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 PRAIRIE DUNES CT
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-2679
Mailing Address - Country:US
Mailing Address - Phone:904-708-7754
Mailing Address - Fax:
Practice Address - Street 1:1050 PRAIRIE DUNES CT
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-2679
Practice Address - Country:US
Practice Address - Phone:904-708-7754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1832103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool