Provider Demographics
NPI:1639199730
Name:MAHONEY, CYDNEY MARIE (MD)
Entity Type:Individual
Prefix:
First Name:CYDNEY
Middle Name:MARIE
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2660 W COVELL BLVD
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-5645
Mailing Address - Country:US
Mailing Address - Phone:530-747-3000
Mailing Address - Fax:530-747-3086
Practice Address - Street 1:2660 W COVELL BLVD
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-5645
Practice Address - Country:US
Practice Address - Phone:530-747-3000
Practice Address - Fax:530-747-3086
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC55389207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME312060099Medicaid
G35242Medicare UPIN
MEMM650502Medicare PIN