Individual ProviderKaela MahoneyPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address3401 Civic Center Blvd, Philadelphia, PA 19104(215) 590-1000(703) 899-7659PECOS EnrollmentBased on the most recent information from CMS, provider Kaela Mahoney does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 5 days ago.Profile DetailsProvider ID1528744430Provider TypeIndividualFull NameMahoney, KaelaCredentialPA-CGenderFemaleSole ProprietorNoEnumeration Date6/26/2023Last Updated7/9/2023Contact InformationPractice LocationPractice Address3401 Civic Center Blvd, Philadelphia, PA 19104Phone(215) 590-1000FaxUnlisted FaxMailing LocationMailing Address4534 Spruce St D2, Philadelphia, PA 19139Phone(703) 899-7659FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363AM0700XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicenseMA063747Pennsylvania