MEDICARE: PRIYA CAVANAUGH RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1396339073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRIYA CAVANAUGH RN

Provider Business Mailing Address
First Line	:	1609 E MOUNT PLEASANT AVE
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19150-1208
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1609 E MOUNT PLEASANT AVE
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19150-1208
Country	:	US
Telephone Number	:	484-954-9329
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2021
Last Update Date	:	02/24/2021

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Directions to “ PRIYA CAVANAUGH RN” Practice Location

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