Provider Demographics
NPI:1144205394
Name:MAHANY, JOHN J JR (PA C)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:J
Last Name:MAHANY
Suffix:JR
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4031 UPPER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SUN CITY CENTER
Mailing Address - State:FL
Mailing Address - Zip Code:33573-6819
Mailing Address - Country:US
Mailing Address - Phone:813-633-2733
Mailing Address - Fax:813-642-0367
Practice Address - Street 1:4031 UPPER CREEK DR
Practice Address - Street 2:
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-6819
Practice Address - Country:US
Practice Address - Phone:813-633-2733
Practice Address - Fax:813-642-0367
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2012-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04672363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2322OtherFLORIDA MEDICAL LIC
TX8G3002Medicare ID - Type Unspecified
TXS59824Medicare UPIN