Provider Demographics
NPI:1386757649
Name:VANNATA, DONNA J (PHD)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:J
Last Name:VANNATA
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 1:14945 LEE HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:AMISSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20106
Mailing Address - Country:US
Mailing Address - Phone:540-222-6875
Mailing Address - Fax:540-937-4640
Practice Address - Street 1:14945 LEE HIGHWAY
Practice Address - Street 2:
Practice Address - City:AMISSVILLE
Practice Address - State:VA
Practice Address - Zip Code:20106
Practice Address - Country:US
Practice Address - Phone:540-222-6875
Practice Address - Fax:540-937-4640
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003256103T00000X
NY0129631103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010014590Medicaid
VA190000857Medicare ID - Type Unspecified
S42247Medicare UPIN