Healthcare Provider Details

I. General information

NPI: 1093928806
Provider Name (Legal Business Name): SUSAN FAY MAHONEY APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 PROFESSORS ROW TUFTS UNIVERSITY HEALTH SERVICE
MEDFORD MA
02155-5816
US

IV. Provider business mailing address

123 FISHER ST
WESTWOOD MA
02090-3618
US

V. Phone/Fax

Practice location:
  • Phone: 617-627-3350
  • Fax: 617-627-3592
Mailing address:
  • Phone: 781-320-8164
  • Fax: 617-627-3592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number163934
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: