Provider Demographics
NPI:1831308022
Name:CUDRIS MALDONADO, JENNIFER (MD)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:
Last Name:CUDRIS MALDONADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:CUDRIS MALDONADO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2801 NE 213TH ST STE 1209
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1267
Mailing Address - Country:US
Mailing Address - Phone:561-409-1767
Mailing Address - Fax:
Practice Address - Street 1:2801 NE 213TH ST STE 1209
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1267
Practice Address - Country:US
Practice Address - Phone:561-409-1767
Practice Address - Fax:305-952-4866
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL130149207RH0003X
MA241710390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program