Provider Demographics
NPI:1235882374
Name:DONNELLY, PATRICIA (PHD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 N OCEAN DR APT 401
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33404-2600
Mailing Address - Country:US
Mailing Address - Phone:203-216-5295
Mailing Address - Fax:
Practice Address - Street 1:5200 N OCEAN DR APT 401
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404-2600
Practice Address - Country:US
Practice Address - Phone:203-216-5295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-29
Last Update Date:2022-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist