Provider Demographics
NPI:1982874236
Name:O MAHONY, KAREN ANN
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:ANN
Last Name:O MAHONY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:ANN
Other - Last Name:SPEIDELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:234E SPRINGMEADOW DR UNIT E
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-4138
Mailing Address - Country:US
Mailing Address - Phone:631-567-3026
Mailing Address - Fax:
Practice Address - Street 1:234E SPRINGMEADOW DR UNIT E
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-4138
Practice Address - Country:US
Practice Address - Phone:631-567-3026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1797431174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist