Provider Demographics
NPI:1447653654
Name:MAHONE, TAMIKA (SPED)
Entity type:Individual
Prefix:
First Name:TAMIKA
Middle Name:
Last Name:MAHONE
Suffix:
Gender:F
Credentials:SPED
Other - Prefix:MRS
Other - First Name:TAMIKA
Other - Middle Name:
Other - Last Name:INGLETON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SPED
Mailing Address - Street 1:350 HOYT AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-2625
Mailing Address - Country:US
Mailing Address - Phone:917-204-5451
Mailing Address - Fax:718-818-8729
Practice Address - Street 1:350 HOYT AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-2625
Practice Address - Country:US
Practice Address - Phone:917-204-5451
Practice Address - Fax:718-818-8729
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-01
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY882338141174400000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No174400000XOther Service ProvidersSpecialist