Provider Demographics
NPI:1639225329
Name:CANNATA, CATHLEEN (NP)
Entity Type:Individual
Prefix:MS
First Name:CATHLEEN
Middle Name:
Last Name:CANNATA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 SUFFOLK AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-4311
Mailing Address - Country:US
Mailing Address - Phone:631-273-3712
Mailing Address - Fax:
Practice Address - Street 1:1719 N OCEAN AVE
Practice Address - Street 2:SUITE D
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-2669
Practice Address - Country:US
Practice Address - Phone:631-758-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY494100-1363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health