Provider Demographics
NPI:1962809749
Name:MACDONALD, ROXANA A
Entity type:Individual
Prefix:MRS
First Name:ROXANA
Middle Name:A
Last Name:MACDONALD
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 1:8220 CLEARY BLVD
Mailing Address - Street 2:APT. 2215
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1382
Mailing Address - Country:US
Mailing Address - Phone:954-297-7050
Mailing Address - Fax:
Practice Address - Street 1:8220 CLEARY BLVD
Practice Address - Street 2:APT. 2215
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1382
Practice Address - Country:US
Practice Address - Phone:954-297-7050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-22
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 13422235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist