Healthcare Provider Details

I. General information

NPI: 1497095384
Provider Name (Legal Business Name): PEGGY LYNN FLYNN MSED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2013
Last Update Date: 06/14/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 VILLA PKWY
HIGHLAND FALLS NY
10928-1615
US

IV. Provider business mailing address

56 VILLA PKWY
HIGHLAND FALLS NY
10928-1615
US

V. Phone/Fax

Practice location:
  • Phone: 845-325-2019
  • Fax: 845-446-2144
Mailing address:
  • Phone: 845-325-2019
  • Fax: 845-446-2144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number857947
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: