Provider Demographics
NPI:1801780572
Name:DONALDSON, DAVID WAYNE
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:WAYNE
Last Name:DONALDSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8270 KIMBALL RD
Mailing Address - Street 2:
Mailing Address - City:BLOSSVALE
Mailing Address - State:NY
Mailing Address - Zip Code:13308-3111
Mailing Address - Country:US
Mailing Address - Phone:315-761-6261
Mailing Address - Fax:
Practice Address - Street 1:8270 KIMBALL RD
Practice Address - Street 2:
Practice Address - City:BLOSSVALE
Practice Address - State:NY
Practice Address - Zip Code:13308-3111
Practice Address - Country:US
Practice Address - Phone:315-761-6261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY356942363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily