Provider Demographics
NPI:1225572977
Name:CONCEPCION, MAYA-SOPHIE
Entity Type:Individual
Prefix:MISS
First Name:MAYA-SOPHIE
Middle Name:
Last Name:CONCEPCION
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 1:233 E 96TH ST APT 2FW
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-0265
Mailing Address - Country:US
Mailing Address - Phone:646-639-9913
Mailing Address - Fax:
Practice Address - Street 1:233 E 96TH ST APT 2FW
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-0265
Practice Address - Country:US
Practice Address - Phone:646-639-9913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-15
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY597424-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool