Provider Demographics
NPI:1235624776
Name:MALLOY, KATHERINE ANN (PA)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANN
Last Name:MALLOY
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:22 SHARI LN
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-4817
Mailing Address - Country:US
Mailing Address - Phone:631-747-3832
Mailing Address - Fax:
Practice Address - Street 1:HSC T12, ROOM 080
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8122
Practice Address - Country:US
Practice Address - Phone:631-444-1116
Practice Address - Fax:631-444-1535
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2022-04-06
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant