Provider Demographics
NPI:1952530842
Name:MEDENARD, MARTA SORAYA (RN)
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:SORAYA
Last Name:MEDENARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 E 163RD ST APT C7
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-3245
Mailing Address - Country:US
Mailing Address - Phone:347-671-1068
Mailing Address - Fax:
Practice Address - Street 1:185 E 163RD ST APT C7
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-3245
Practice Address - Country:US
Practice Address - Phone:347-671-1068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY480239163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse