Provider Demographics
NPI:1952950206
Name:HENNEBERY, MAYA
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:HENNEBERY
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 1:5 GLEN DR
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-1503
Mailing Address - Country:US
Mailing Address - Phone:845-518-9334
Mailing Address - Fax:
Practice Address - Street 1:5 GLEN DR
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-1503
Practice Address - Country:US
Practice Address - Phone:845-518-9334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty