Provider Demographics
NPI:1891754487
Name:MAYOTT, CATHERINE K (NP)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:K
Last Name:MAYOTT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:CATHERINE
Other - Middle Name:
Other - Last Name:KREYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:63 SHAKER RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12204-1030
Mailing Address - Country:US
Mailing Address - Phone:518-207-2710
Mailing Address - Fax:518-207-2713
Practice Address - Street 1:400 PATROON CREEK BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-5013
Practice Address - Country:US
Practice Address - Phone:518-459-8106
Practice Address - Fax:518-489-6441
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302332363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02043350Medicaid
NYS85454Medicare UPIN
NYRA1893Medicare ID - Type Unspecified