Provider Demographics
NPI:1528400975
Name:MAHONEY, DIANA SHEA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:SHEA
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:SHEA
Other - Last Name:BARRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:73D WINTHROP AVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-3716
Mailing Address - Country:US
Mailing Address - Phone:978-686-3017
Mailing Address - Fax:978-685-4280
Practice Address - Street 1:73D WINTHROP AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-3716
Practice Address - Country:US
Practice Address - Phone:978-686-3017
Practice Address - Fax:978-685-4280
Is Sole Proprietor?:No
Enumeration Date:2013-07-26
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2269660363LF0000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily