Provider Demographics
NPI:1902097397
Name:DONNELLY, PAJA LEE (CNS NP IN PSYCHIATRY)
Entity Type:Individual
Prefix:DR
First Name:PAJA
Middle Name:LEE
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:CNS NP IN PSYCHIATRY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71-21 244 ST
Mailing Address - Street 2:WINCHESTER CONSULTATION CENTER
Mailing Address - City:DOUGLASTON
Mailing Address - State:NY
Mailing Address - Zip Code:11362-1913
Mailing Address - Country:US
Mailing Address - Phone:718-224-9193
Mailing Address - Fax:
Practice Address - Street 1:71 21 244 ST
Practice Address - Street 2:WINCHESTER CONSULTATION
Practice Address - City:DOUGLASTON
Practice Address - State:NY
Practice Address - Zip Code:11362-1913
Practice Address - Country:US
Practice Address - Phone:718-224-9193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2195251163W00000X
NYF400512363LP0808X
NY0108674364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB2E9201Medicare PIN