Provider Demographics
NPI:1649615154
Name:MAHON-DAVENDA, MYLAH NICOLE (NP)
Entity type:Individual
Prefix:
First Name:MYLAH
Middle Name:NICOLE
Last Name:MAHON-DAVENDA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MYLAH
Other - Middle Name:NICOLE
Other - Last Name:MAHON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:141 DAYTON ST
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-1016
Mailing Address - Country:US
Mailing Address - Phone:781-608-1968
Mailing Address - Fax:
Practice Address - Street 1:565 TURNPIKE ST STE 85
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-5936
Practice Address - Country:US
Practice Address - Phone:978-519-4114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-10
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2277802363LA2100X, 363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily