Provider Demographics
NPI:1396403663
Name:MACHADO, MARIA ELENA (LPN)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ELENA
Last Name:MACHADO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1361 FORESTBURGH RD
Mailing Address - Street 2:
Mailing Address - City:GLEN SPEY
Mailing Address - State:NY
Mailing Address - Zip Code:12737-5346
Mailing Address - Country:US
Mailing Address - Phone:845-637-8121
Mailing Address - Fax:
Practice Address - Street 1:15 FORTUNE RD
Practice Address - Street 2:
Practice Address - City:WEST MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941
Practice Address - Country:US
Practice Address - Phone:845-637-8121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211448-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse