Provider Demographics
NPI:1366129561
Name:DOHONEY, MITAWA
Entity type:Individual
Prefix:
First Name:MITAWA
Middle Name:
Last Name:DOHONEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 GOLF TER
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-4728
Mailing Address - Country:US
Mailing Address - Phone:516-209-7883
Mailing Address - Fax:
Practice Address - Street 1:15 FORTUNE ROAD
Practice Address - Street 2:
Practice Address - City:WEST MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941
Practice Address - Country:US
Practice Address - Phone:845-330-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY720177163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse