Paja Lee Donnelly, CNS NP IN PSYCHIATRY

Key facts

NPI

1902097397

Entity type

Individual (NPI type 1)

Primary specialty

Registered Nurse 163W00000X

License

2195251 (NY)

Practice address

71 21 244 St
Winchester Consultation
Douglaston, NY 11362-1913

Phone

(718) 224-9193

NPI assigned

Aug 9, 2007

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Certified Nurse Specialist, Nurse Practitioner

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 9, 2007.

{
    "created_epoch": "1186617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1186617600000",
    "number": "1902097397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "71-21 244 ST",
            "address_2": "WINCHESTER CONSULTATION CENTER",
            "city": "DOUGLASTON",
            "state": "NY",
            "postal_code": "113621913",
            "telephone_number": "718-224-9193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "71 21 244 ST",
            "address_2": "WINCHESTER CONSULTATION",
            "city": "DOUGLASTON",
            "state": "NY",
            "postal_code": "113621913",
            "telephone_number": "718-224-9193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DONNELLY",
        "first_name": "PAJA",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "CNS NP IN PSYCHIATRY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-09",
        "last_updated": "2007-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "2195251",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "F400512",
            "primary": false
        },
        {
            "code": "364S00000X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist",
            "state": "NY",
            "license": "0108674",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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