Provider Demographics
NPI:1568014355
Name:LYONS, MONAE
Entity Type:Individual
Prefix:
First Name:MONAE
Middle Name:
Last Name:LYONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MONAE
Other - Middle Name:
Other - Last Name:LYONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19 ROBINSON RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NY
Mailing Address - Zip Code:13323-1418
Mailing Address - Country:US
Mailing Address - Phone:315-281-3138
Mailing Address - Fax:
Practice Address - Street 1:320 PARKDRIVE MNAOR 2
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-4749
Practice Address - Country:US
Practice Address - Phone:315-281-3138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator