Provider Demographics
NPI:1316908114
Name:MONAGHAN, CYNTHIA M (FNP)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:M
Last Name:MONAGHAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:M
Other - Last Name:MALONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 689
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12181-0689
Mailing Address - Country:US
Mailing Address - Phone:518-268-5000
Mailing Address - Fax:
Practice Address - Street 1:147 HOOSICK ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2393
Practice Address - Country:US
Practice Address - Phone:518-268-5380
Practice Address - Fax:518-268-5709
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY330797363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01777802Medicaid
S09674Medicare UPIN
NY01777802Medicaid