Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service | PY10525 | FL |
NPI | 1215599766 |
---|---|
Provider Name | Dr. Stephanie Rita Mcdonough |
First Address | Gainesville, FL 32610-0165 |
Second Address | Gainesville, FL 32610-3003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2019 |
Last Update Date | 27/01/2020 |