Provider Demographics
NPI:1619377173
Name:MCNALLY, KATERINA DESIREE
Entity Type:Individual
Prefix:
First Name:KATERINA
Middle Name:DESIREE
Last Name:MCNALLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATERINA
Other - Middle Name:DESIREE
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:968 MAUMEE ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-5185
Mailing Address - Country:US
Mailing Address - Phone:407-247-6043
Mailing Address - Fax:
Practice Address - Street 1:968 MAUMEE ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-5185
Practice Address - Country:US
Practice Address - Phone:407-247-6043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-02
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health