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General NPI Number Information
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NPI Number | 1811002868
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Entity Type | Individual
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Provider Name | SALLY CATHERINE MONAHAN NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 44210 COUNTY ROAD 48
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City | SOUTHOLD
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State | NY
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Zip | 11971-5032
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Country | US
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Telephone | 631-765-4150
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Fax | 631-765-4688
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Provider Business Mailing Address
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Address Line | PO BOX 1559
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City | STONY BROOK
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State | NY
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Zip | 11790-0989
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Country | US
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Telephone | 631-852-1803
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Fax | 631-852-3723
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | F332909-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F332909-1
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License Number State | NY
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