Provider Demographics
NPI:1407923725
Name:MCBRIDE, DONYELLE VONISE
Entity Type:Individual
Prefix:MS
First Name:DONYELLE
Middle Name:VONISE
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 PARK RD
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-2014
Mailing Address - Country:US
Mailing Address - Phone:860-985-2081
Mailing Address - Fax:860-920-7365
Practice Address - Street 1:211 PARK RD
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-2014
Practice Address - Country:US
Practice Address - Phone:860-985-2081
Practice Address - Fax:860-920-7368
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT046491174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist