Provider Demographics
NPI:1497125496
Name:SLAYTON, MARY (NPP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:SLAYTON
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 IVES RD
Mailing Address - Street 2:
Mailing Address - City:HARPURSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13787-1851
Mailing Address - Country:US
Mailing Address - Phone:606-372-8202
Mailing Address - Fax:
Practice Address - Street 1:162 IVES RD
Practice Address - Street 2:
Practice Address - City:HARPURSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13787-1851
Practice Address - Country:US
Practice Address - Phone:607-372-8202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-02
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY400003363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health