Provider Demographics
NPI:1770866725
Name:MALDONADO, MAHA YVONNE
Entity Type:Individual
Prefix:
First Name:MAHA
Middle Name:YVONNE
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 1:355 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-3216
Mailing Address - Country:US
Mailing Address - Phone:718-855-2292
Mailing Address - Fax:718-855-2297
Practice Address - Street 1:355 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-3216
Practice Address - Country:US
Practice Address - Phone:718-855-2292
Practice Address - Fax:718-855-2297
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056304183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist