Provider Demographics
NPI:1851652929
Name:BANOS, MAYRA ELIZABETH
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:ELIZABETH
Last Name:BANOS
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 1:6641 SAUNDERS ST
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4635
Mailing Address - Country:US
Mailing Address - Phone:347-497-1402
Mailing Address - Fax:
Practice Address - Street 1:6641 SAUNDERS ST
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4635
Practice Address - Country:US
Practice Address - Phone:347-497-1402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator