Provider Demographics
NPI:1093506537
Name:MAYNARD, ARLENE
Entity type:Individual
Prefix:
First Name:ARLENE
Middle Name:
Last Name:MAYNARD
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 1:2035 SEAGIRT BLVD APT 3D
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-2936
Mailing Address - Country:US
Mailing Address - Phone:347-678-7125
Mailing Address - Fax:
Practice Address - Street 1:2035 SEAGIRT BLVD APT 3D
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-2936
Practice Address - Country:US
Practice Address - Phone:347-678-7125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN