Provider Demographics
NPI:1558751982
Name:MALLAHY, AMANDA MARY (PA)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:MARY
Last Name:MALLAHY
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:58 OAKLAND AVE
Mailing Address - Street 2:APARTMENT B
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-3373
Mailing Address - Country:US
Mailing Address - Phone:631-664-6968
Mailing Address - Fax:516-295-2487
Practice Address - Street 1:16450 CROSSBAY BLVD
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-3742
Practice Address - Country:US
Practice Address - Phone:718-843-3366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-22
Last Update Date:2015-10-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY018299-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant