Provider Demographics
NPI:1679078240
Name:BLEAKNEY-HANLON, KATHLEEN SIOBHAN (ND)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:SIOBHAN
Last Name:BLEAKNEY-HANLON
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 S COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:E PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-5454
Mailing Address - Country:US
Mailing Address - Phone:631-394-0399
Mailing Address - Fax:
Practice Address - Street 1:734 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:BAYPORT
Practice Address - State:NY
Practice Address - Zip Code:11705-1621
Practice Address - Country:US
Practice Address - Phone:631-394-0399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT099.0087995175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath