Provider Demographics
NPI:1598012544
Name:MAHONEY, MICHELLE JOI (LPN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:JOI
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 SAINT JOHNS PL
Mailing Address - Street 2:APT C8
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-2550
Mailing Address - Country:US
Mailing Address - Phone:347-365-4921
Mailing Address - Fax:
Practice Address - Street 1:381 PARK AVE S
Practice Address - Street 2:STE 1020
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-8806
Practice Address - Country:US
Practice Address - Phone:212-260-6078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY290750164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse