Provider Demographics
NPI:1447253463
Name:JOHNSTON, DONNA CHERYLL (MD)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:CHERYLL
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DONNA
Other - Middle Name:JOHNSTON
Other - Last Name:BADOLATO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8061 SPYGLASS HILL RD. SUITE 102
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940
Mailing Address - Country:US
Mailing Address - Phone:321-751-7041
Mailing Address - Fax:351-751-7042
Practice Address - Street 1:8061 SPYGLASS HILL RD. SUITE 102
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940
Practice Address - Country:US
Practice Address - Phone:321-751-7041
Practice Address - Fax:351-751-7042
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 76813207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL49715OtherBLUE CROSS BLUE SHIELD
FL259842600Medicaid
FL7158131OtherAETNA INSURANCE
FL49715OtherBLUE CROSS BLUE SHIELD
FLH21999Medicare UPIN