Healthcare Provider Details

I. General information

NPI: 1215708375
Provider Name (Legal Business Name): RACHEL MAHONY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2024
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 SOUTH AVE STE 307
STATEN ISLAND NY
10314-3421
US

IV. Provider business mailing address

1200 SOUTH AVE STE 307
STATEN ISLAND NY
10314-3421
US

V. Phone/Fax

Practice location:
  • Phone: 718-698-3777
  • Fax:
Mailing address:
  • Phone: 718-698-3777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number350781
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: