Provider Demographics
NPI:1487728754
Name:MOLLOY, DEBORAH ASHTON (MS,APRN)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ASHTON
Last Name:MOLLOY
Suffix:
Gender:F
Credentials:MS,APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1781 HIGHLAND AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-1254
Mailing Address - Country:US
Mailing Address - Phone:203-272-1990
Mailing Address - Fax:203-271-0668
Practice Address - Street 1:1781 HIGHLAND AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-1254
Practice Address - Country:US
Practice Address - Phone:203-272-1990
Practice Address - Fax:203-271-0668
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000024363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000024OtherCONNECTICARE
CT2V2619OtherHEALTHNET
CT400000024CT01OtherBLUE SHIELD
CT500002331Medicare PIN