Provider Demographics
NPI:1770845778
Name:JORDAN, PAULA MAUREEN (MS)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:MAUREEN
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:PAULA
Other - Middle Name:MAUREEN
Other - Last Name:RHONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:41 SPICE MILL BLVD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-2637
Mailing Address - Country:US
Mailing Address - Phone:518-577-8869
Mailing Address - Fax:
Practice Address - Street 1:597 3RD AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12182-2509
Practice Address - Country:US
Practice Address - Phone:518-233-0544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist