Provider Demographics
NPI:1720171283
Name:CAVANAUGH, DEBORAH SUSAN (MD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:SUSAN
Last Name:CAVANAUGH
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73-4331 KAKAHIAKA ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-9548
Mailing Address - Country:US
Mailing Address - Phone:605-321-2549
Mailing Address - Fax:
Practice Address - Street 1:836 5TH AVE
Practice Address - Street 2:
Practice Address - City:BELLE FOURCHE
Practice Address - State:SD
Practice Address - Zip Code:57717-1607
Practice Address - Country:US
Practice Address - Phone:832-604-3771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD51992084P0800X
HIMD-230812084P0800X
MN455232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7100513Medicaid
SD7100518Medicaid
SD7100518Medicaid
SD41411Medicare ID - Type Unspecified
SD7100513Medicaid