Provider Demographics
NPI:1508297524
Name:FLAHERTY, AMY LOUISE (PA-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LOUISE
Last Name:FLAHERTY
Suffix:
Gender:F
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 1:267 HUNTSVILLE IDETOWN RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-3143
Mailing Address - Country:US
Mailing Address - Phone:570-947-0026
Mailing Address - Fax:
Practice Address - Street 1:451 3RD AVE STE 1
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5802
Practice Address - Country:US
Practice Address - Phone:570-288-6543
Practice Address - Fax:855-263-1675
Is Sole Proprietor?:No
Enumeration Date:2013-12-01
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA056629363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical