Provider Demographics
NPI:1174947428
Name:MACENO, NYKA
Entity type:Individual
Prefix:
First Name:NYKA
Middle Name:
Last Name:MACENO
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 1:465 UPPER RIVERDALE RD SW STE 2
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2529
Mailing Address - Country:US
Mailing Address - Phone:404-246-9184
Mailing Address - Fax:
Practice Address - Street 1:465 UPPER RIVERDALE RD SW STE 2
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2529
Practice Address - Country:US
Practice Address - Phone:678-390-5252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-06
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No374J00000XNursing Service Related ProvidersDoula