Provider Demographics
NPI:1013529619
Name:MAYE, TATIWAN A
Entity Type:Individual
Prefix:
First Name:TATIWAN
Middle Name:A
Last Name:MAYE
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 PACIFIC ST
Mailing Address - Street 2:
Mailing Address - City:COPIAGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11726-1130
Mailing Address - Country:US
Mailing Address - Phone:631-639-9505
Mailing Address - Fax:
Practice Address - Street 1:355 PACIFIC ST
Practice Address - Street 2:
Practice Address - City:COPIAGUE
Practice Address - State:NY
Practice Address - Zip Code:11726-1130
Practice Address - Country:US
Practice Address - Phone:631-639-9505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)