Provider Demographics
NPI:1720429343
Name:MALDANIS, CHERYL (FNP)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:MALDANIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6435 S FM 549
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HEATH
Mailing Address - State:TX
Mailing Address - Zip Code:75032-6220
Mailing Address - Country:US
Mailing Address - Phone:972-771-9155
Mailing Address - Fax:972-771-2390
Practice Address - Street 1:6435 S FM 549
Practice Address - Street 2:SUITE 201
Practice Address - City:HEATH
Practice Address - State:TX
Practice Address - Zip Code:75032-6220
Practice Address - Country:US
Practice Address - Phone:972-771-9155
Practice Address - Fax:972-771-2390
Is Sole Proprietor?:No
Enumeration Date:2013-07-11
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX720876363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX322966801Medicaid
TX322966802Medicaid
TX322966801Medicaid
TX304298YKY6Medicare PIN