Provider Demographics
NPI:1962736892
Name:MONAHAN, DEIRDRE LYNN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:DEIRDRE
Middle Name:LYNN
Last Name:MONAHAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DEIRDRE
Other - Middle Name:LYNN
Other - Last Name:FOISY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:147 KILLINGLY AVE
Mailing Address - Street 2:
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260
Mailing Address - Country:US
Mailing Address - Phone:860-928-6541
Mailing Address - Fax:
Practice Address - Street 1:320 POMFRET ST
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260
Practice Address - Country:US
Practice Address - Phone:860-928-7503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-24
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMAPA4438363AM0700X
FLPA9110356363AM0700X
CT002327363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical