Provider Demographics
NPI:1326827098
Name:DEJESUS, MAIARA MICHELLE SALES
Entity Type:Individual
Prefix:MRS
First Name:MAIARA
Middle Name:MICHELLE SALES
Last Name:DEJESUS
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 1:3433 S COURT ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36105-1607
Mailing Address - Country:US
Mailing Address - Phone:334-922-4141
Mailing Address - Fax:
Practice Address - Street 1:4137 CARMICHAEL RD STE 330
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-3614
Practice Address - Country:US
Practice Address - Phone:334-922-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care