MEDICARE: EBONY MALDONADO

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	104100000X	Social Worker
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1205706959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EBONY MALDONADO

Provider Business Mailing Address
First Line	:	5580 ANGEL OAKS DR
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27105-9112
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5580 ANGEL OAKS DR
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27105-9112
Country	:	US
Telephone Number	:	929-351-7288
Fax Number	:

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

Provider Enumeration Date	:	11/07/2025
Last Update Date	:	11/07/2025

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Directions to “ EBONY MALDONADO ” Practice Location

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