Provider Demographics
NPI:1831451459
Name:MONAHAN, PATRICIA M (MSED)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:MONAHAN
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 GARDEN LN
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-1111
Mailing Address - Country:US
Mailing Address - Phone:607-785-1376
Mailing Address - Fax:
Practice Address - Street 1:241 GARDEN LN
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-1111
Practice Address - Country:US
Practice Address - Phone:607-343-9978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-10
Last Update Date:2012-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist