Provider Demographics
NPI:1518520196
Name:DONALDSON, KEYSHON
Entity Type:Individual
Prefix:
First Name:KEYSHON
Middle Name:
Last Name:DONALDSON
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 1:6419 CHANTRY ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-1310
Mailing Address - Country:US
Mailing Address - Phone:407-883-3770
Mailing Address - Fax:
Practice Address - Street 1:6419 CHANTRY ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-1310
Practice Address - Country:US
Practice Address - Phone:407-883-3770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-18
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty