Provider Demographics
NPI:1922430503
Name:ADDISON, DONNA (BA,MS, SAS, SDA,)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:
Last Name:ADDISON
Suffix:
Gender:F
Credentials:BA,MS, SAS, SDA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11510 229TH ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11411-1408
Mailing Address - Country:US
Mailing Address - Phone:718-610-9788
Mailing Address - Fax:
Practice Address - Street 1:11510 229TH ST
Practice Address - Street 2:
Practice Address - City:CAMBRIA HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11411-1408
Practice Address - Country:US
Practice Address - Phone:718-610-9788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No171W00000XOther Service ProvidersContractor