Basic Information
Provider Information
NPI: 1407420391
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DONDA
FirstName: ASHLEY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 19 BRADHURST AVE STE 3100N
Address2:  
City: HAWTHORNE
State: NY
PostalCode: 105322140
CountryCode: US
TelephoneNumber: 9149099018
FaxNumber: 9149099028
Practice Location
Address1: 100 WOODS RD
Address2:  
City: VALHALLA
State: NY
PostalCode: 105951530
CountryCode: US
TelephoneNumber: 9149096900
FaxNumber: 9144932828
Other Information
ProviderEnumerationDate: 05/17/2021
LastUpdateDate: 06/24/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/24/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X024891NYY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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