Provider Demographics
NPI:1124315171
Name:MCDONALD, SYNAVA
Entity type:Individual
Prefix:MS
First Name:SYNAVA
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1881 W ALEXANDER RD UNIT 2100
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-9049
Mailing Address - Country:US
Mailing Address - Phone:702-374-3606
Mailing Address - Fax:
Practice Address - Street 1:7381 PRAIRIE FALCON RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0811
Practice Address - Country:US
Practice Address - Phone:702-646-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner