Provider Demographics
NPI:1811002868
Name:MONAHAN, SALLY CATHERINE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:CATHERINE
Last Name:MONAHAN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-0989
Mailing Address - Country:US
Mailing Address - Phone:631-852-1803
Mailing Address - Fax:631-852-3723
Practice Address - Street 1:44210 COUNTY ROAD 48
Practice Address - Street 2:
Practice Address - City:SOUTHOLD
Practice Address - State:NY
Practice Address - Zip Code:11971-5032
Practice Address - Country:US
Practice Address - Phone:631-765-4150
Practice Address - Fax:631-765-4688
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332909-1363LG0600X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00473170Medicaid
NYS51541Medicare UPIN