MEDICARE: DENYSE M MAHONEY PA

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	363A00000X	Physician Assistant	PA 9102595	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	361919	OTHER	FL	AVMED
2	680669	OTHER	FL	WELLCARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	9612235	OTHER	FL	AETNA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871676569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENYSE M MAHONEY PA

Provider Business Mailing Address
First Line	:	2234 COLONIAL BLVD
Second Line	:	MANAGED CARE DEPARTMENT
City	:	FORT MYERS
State	:	FL
Zip	:	33907-1412
Country	:	US
Telephone Number	:	239-931-7342
Fax Number	:	239-931-7385

Provider Business Practice Location Address
First Line	:	8931 COLONIAL CENTER DR
Second Line	:	SUITE 400
City	:	FORT MYERS
State	:	FL
Zip	:	33905-7816
Country	:	US
Telephone Number	:	239-334-6626
Fax Number	:	239-334-0404

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	12/14/2016

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Directions to “ DENYSE M MAHONEY PA” Practice Location

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