Provider Demographics
NPI:1669832457
Name:XYNIDIS, DONNA C (MS, SLP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:C
Last Name:XYNIDIS
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6215 LORRAINE RD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-6708
Mailing Address - Country:US
Mailing Address - Phone:941-755-1400
Mailing Address - Fax:941-755-3735
Practice Address - Street 1:216 BIRKDALE DR
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32124-2050
Practice Address - Country:US
Practice Address - Phone:386-864-9877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-07
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 14264235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist