Provider Demographics
NPI:1639388044
Name:MCCANN, MAUREEN VERONICA (NP)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:VERONICA
Last Name:MCCANN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:VERONICA
Other - Last Name:ANDREOZZI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2820 SHIPYARD LN
Mailing Address - Street 2:UNIT 3M
Mailing Address - City:EAST MARION
Mailing Address - State:NY
Mailing Address - Zip Code:11939-1259
Mailing Address - Country:US
Mailing Address - Phone:631-477-2489
Mailing Address - Fax:
Practice Address - Street 1:150 DARK HOLLOW RD
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2048
Practice Address - Country:US
Practice Address - Phone:631-473-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2011-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY340175363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology