Provider Demographics
NPI:1124362439
Name:MCMAHON, PATRICIA L (RN)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:L
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:SEVENSKY
Other - Last Name:MCMAHON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:2021 LOUIS KOSSUTH AVE
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-6318
Mailing Address - Country:US
Mailing Address - Phone:631-648-4540
Mailing Address - Fax:
Practice Address - Street 1:99 HOLLYWOOD DR
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3135
Practice Address - Country:US
Practice Address - Phone:631-366-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196921-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse