MEDICARE: EMILY MALDONADO LM, CPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	176B00000X	Midwife	MW379	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NONE	OTHER		NONE

General Provider Information

NPI Number	:	1194468041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY MALDONADO LM, CPM

Provider Business Mailing Address
First Line	:	1746 EASTBROOK BLVD
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-2436
Country	:	US
Telephone Number	:	407-312-2670
Fax Number	:

Provider Business Practice Location Address
First Line	:	1746 EASTBROOK BLVD
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-2436
Country	:	US
Telephone Number	:	407-312-2670
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2022
Last Update Date	:	04/19/2022

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