Healthcare Provider Details

I. General information

NPI: 1013054808
Provider Name (Legal Business Name): SUSAN T CAVANAGH N.P., C.N.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1985 CROMPOND RD BUILDING B
CORTLANDT MANOR NY
10567-4146
US

IV. Provider business mailing address

1985 CROMPOND RD
CORTLANDT MANOR NY
10567-4146
US

V. Phone/Fax

Practice location:
  • Phone: 914-739-1697
  • Fax: 914-739-0973
Mailing address:
  • Phone: 914-739-1697
  • Fax: 914-739-0973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0002X
TaxonomyHigh-Risk Obstetric Registered Nurse
License Number277534-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberF360158-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberF000117-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: