Provider Demographics
NPI:1538473731
Name:FLAHERTY, CAROLYN MARY (RN)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:MARY
Last Name:FLAHERTY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:CAROLYN
Other - Middle Name:MARY
Other - Last Name:KOHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:31 SEQUAMS LANE
Mailing Address - Street 2:
Mailing Address - City:W. ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795
Mailing Address - Country:US
Mailing Address - Phone:631-669-8377
Mailing Address - Fax:
Practice Address - Street 1:31 SEQUAMS LANE
Practice Address - Street 2:
Practice Address - City:W. ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795
Practice Address - Country:US
Practice Address - Phone:631-669-8377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-29
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22568176163W00000X
NY305943363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse