Provider Demographics
NPI:1649015934
Name:BROOKS, MARIAH CANDIDA
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:CANDIDA
Last Name:BROOKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SAKINAH
Other - Middle Name:CANDIDA
Other - Last Name:ASADULLAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:103 STERLING ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-3318
Mailing Address - Country:US
Mailing Address - Phone:413-461-6205
Mailing Address - Fax:
Practice Address - Street 1:158 E 115TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-2025
Practice Address - Country:US
Practice Address - Phone:646-683-6463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY092023-6374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula