Provider Demographics
NPI:1710314893
Name:MALDONADO, MELINA
Entity Type:Individual
Prefix:
First Name:MELINA
Middle Name:
Last Name:MALDONADO
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 1:628 ELDERT LN
Mailing Address - Street 2:2J
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-3359
Mailing Address - Country:US
Mailing Address - Phone:917-450-1306
Mailing Address - Fax:
Practice Address - Street 1:628 ELDERT LN
Practice Address - Street 2:2J
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-3359
Practice Address - Country:US
Practice Address - Phone:917-450-1306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3596986174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist