Provider Demographics
NPI:1609876804
Name:MALDONADO-MEDINA, ANABELLE (MD)
Entity Type:Individual
Prefix:
First Name:ANABELLE
Middle Name:
Last Name:MALDONADO-MEDINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANABELLE
Other - Middle Name:
Other - Last Name:MALDONADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1190 NW 95 STREET
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33150-2064
Mailing Address - Country:US
Mailing Address - Phone:305-836-5053
Mailing Address - Fax:305-836-9727
Practice Address - Street 1:1190 NW 95 STREET
Practice Address - Street 2:SUITE 204
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33150-2064
Practice Address - Country:US
Practice Address - Phone:305-836-5053
Practice Address - Fax:305-836-9727
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 00498212084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12606OtherVISTA
FL4076902OtherAETNA
FL650123120Medicaid
FL003580OtherNHP
FL014296OtherAVMED
FL04348OtherBLUE CROSS BLUE SHIELD
FLN1997OtherWELLCARE
FL130009510OtherRAILROAD MEDICARE
FL228896OtherAMERIGROUP
FL228896OtherAMERIGROUP
FLN1997OtherWELLCARE