Provider Demographics
NPI:1194468041
Name:MALDONADO, EMILY (LM, CPM)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:NIEDERMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LM
Mailing Address - Street 1:1746 EASTBROOK BLVD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-2436
Mailing Address - Country:US
Mailing Address - Phone:407-312-2670
Mailing Address - Fax:
Practice Address - Street 1:1746 EASTBROOK BLVD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-2436
Practice Address - Country:US
Practice Address - Phone:407-312-2670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW379176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE