Provider Demographics
NPI:1083735344
Name:FLAHERTY, SERENA C (APRN CPNP)
Entity Type:Individual
Prefix:
First Name:SERENA
Middle Name:C
Last Name:FLAHERTY
Suffix:
Gender:F
Credentials:APRN CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:OLD GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06870-2228
Mailing Address - Country:US
Mailing Address - Phone:203-231-1967
Mailing Address - Fax:
Practice Address - Street 1:3009 BROADWAY
Practice Address - Street 2:BARNARD COLLEGE PRIMARY CARE HEALTH SERVICES
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-6909
Practice Address - Country:US
Practice Address - Phone:212-854-2091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003487363LP0200X
NY382040363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics