Provider Demographics
NPI:1316118599
Name:MAHONEY, PATRICIA J (RN)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:J
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:PATRICIA
Other - Middle Name:J
Other - Last Name:KENNY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:540 EAST MAIN STREET
Mailing Address - Street 2:JUST KID
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901
Mailing Address - Country:US
Mailing Address - Phone:631-369-1927
Mailing Address - Fax:631-369-1957
Practice Address - Street 1:887 KELLUM STREET
Practice Address - Street 2:JUST KIDS
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757
Practice Address - Country:US
Practice Address - Phone:631-884-3000
Practice Address - Fax:831-884-1959
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4956101163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse