Provider Demographics
NPI:1770606097
Name:O'BRAY-DONOHUE, LYNNANN S (AUD)
Entity type:Individual
Prefix:MRS
First Name:LYNNANN
Middle Name:S
Last Name:O'BRAY-DONOHUE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:MRS
Other - First Name:LYNNANN
Other - Middle Name:S
Other - Last Name:O'BRAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AUD
Mailing Address - Street 1:4747-8 NESCONSET HWY
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-2878
Mailing Address - Country:US
Mailing Address - Phone:631-331-6455
Mailing Address - Fax:
Practice Address - Street 1:4747-8 NESCONSET HWY
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-2878
Practice Address - Country:US
Practice Address - Phone:631-331-6455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001038231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYM03451Medicare ID - Type Unspecified