Provider Demographics
NPI:1457867673
Name:MAHONY, SHANNON PAIGE
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:PAIGE
Last Name:MAHONY
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 1:39 JOHN ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-3821
Mailing Address - Country:US
Mailing Address - Phone:845-331-7080
Mailing Address - Fax:
Practice Address - Street 1:166 ALBANY AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-2530
Practice Address - Country:US
Practice Address - Phone:845-331-7080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-26
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator