Healthcare Provider Details

I. General information

NPI: 1538473731
Provider Name (Legal Business Name): CAROLYN MARY FLAHERTY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. CAROLYN MARY KOHLER

II. Dates (important events)

Enumeration Date: 07/29/2010
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 SEQUAMS LANE
W. ISLIP NY
11795
US

IV. Provider business mailing address

31 SEQUAMS LANE
W. ISLIP NY
11795
US

V. Phone/Fax

Practice location:
  • Phone: 631-669-8377
  • Fax:
Mailing address:
  • Phone: 631-669-8377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number305943
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number402764
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number22568176
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: