Provider Demographics
NPI:1043539463
Name:MCMAHON-KARDOS, JOAN MARIE
Entity Type:Individual
Prefix:
First Name:JOAN MARIE
Middle Name:
Last Name:MCMAHON-KARDOS
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 1:8708 TREASURE CAY
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-5502
Mailing Address - Country:US
Mailing Address - Phone:845-587-7179
Mailing Address - Fax:
Practice Address - Street 1:12 SILVESTRO WAY
Practice Address - Street 2:
Practice Address - City:GARNERVILLE
Practice Address - State:NY
Practice Address - Zip Code:10923-1835
Practice Address - Country:US
Practice Address - Phone:845-551-7670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY350885163W00000X
FLRN9563356163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1043539463Medicaid