Healthcare Provider Details

I. General information

NPI: 1134782303
Provider Name (Legal Business Name): PATRICIA LEE VAUGHN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PATRICIA LEE DUNHAM RN

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 04/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 NORTH ST
HARRISON NY
10528-1140
US

IV. Provider business mailing address

116 WOODS BROOKE CIR
OSSINING NY
10562-2094
US

V. Phone/Fax

Practice location:
  • Phone: 914-967-6500
  • Fax:
Mailing address:
  • Phone: 914-262-6220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number210859-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: