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General NPI Number Information
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NPI Number | 1649480294
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Entity Type | Individual
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Provider Name | MICHELE MARIE MAHON MD
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Gender | Female
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 08/08/2019
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Provider Practice Location Address
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Address Line | 197 HALF HOLLOW RD
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City | DIX HILLS
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State | NY
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Zip | 11746-5861
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Country | US
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Telephone | 631-370-1622
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Fax |
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Provider Business Mailing Address
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Address Line | 197 HALF HOLLOW RD
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City | DIX HILLS
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State | NY
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Zip | 11746-5861
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Country | US
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Telephone | 631-370-1622
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 229850
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 229850
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License Number State | NY
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