Provider Demographics
NPI:1619074358
Name:FLEISCHAKER, DONNI T (MD)
Entity Type:Individual
Prefix:DR
First Name:DONNI
Middle Name:T
Last Name:FLEISCHAKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3933 E EDNA AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2127
Mailing Address - Country:US
Mailing Address - Phone:602-992-4246
Mailing Address - Fax:602-482-4640
Practice Address - Street 1:3933 E EDNA AVE
Practice Address - Street 2:STE 102
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2127
Practice Address - Country:US
Practice Address - Phone:602-992-4246
Practice Address - Fax:602-482-4640
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17503101YA0400X, 101YM0800X, 103T00000X, 103TB0200X, 103TP2701X, 174400000X, 207Q00000X, 2080P0006X, 251S00000X, 261QM0801X, 208000000X, 103TB0200X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No174400000XOther Service ProvidersSpecialist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ279168OtherDES
AZ4077245OtherAETNA
70441OtherPACIFICARE
AZ1902518988OtherASSOCIATED NPI NOVA MEDICAL ASSOCIATES
AZ3324076-007OtherCIGNA
AZAZ0864000OtherBCBS
AZ1Z7395OtherHEALTHNET
AZ279168003Medicaid