Provider Demographics
NPI:1497380281
Name:MCDONALD, SHYNIECE
Entity Type:Individual
Prefix:
First Name:SHYNIECE
Middle Name:
Last Name:MCDONALD
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 1:3501 BRISTOL OXFORD VALLEY RD APT 708
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19057-2911
Mailing Address - Country:US
Mailing Address - Phone:856-465-1404
Mailing Address - Fax:
Practice Address - Street 1:3501 BRISTOL OXFORD VALLEY RD APT 708
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19057-2911
Practice Address - Country:US
Practice Address - Phone:856-465-1404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Single Specialty