Basic Information
| Provider Information | |||||||||
| NPI: | 1487728754 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOLLOY | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | ASHTON | ||||||||
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| Credential: | MS,APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1781 HIGHLAND AVE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | CHESHIRE | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064101254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032721990 | ||||||||
| FaxNumber: | 2032710668 | ||||||||
| Practice Location | |||||||||
| Address1: | 1781 HIGHLAND AVE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | CHESHIRE | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064101254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032721990 | ||||||||
| FaxNumber: | 2032710668 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2006 | ||||||||
| LastUpdateDate: | 07/14/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | 000024 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
ID Information
| ID | Type | State | Issuer | Description | 000024 | 01 | CT | CONNECTICARE | OTHER | 2V2619 | 01 | CT | HEALTHNET | OTHER | 400000024CT01 | 01 | CT | BLUE SHIELD | OTHER |