MEDICARE: MAYA MANGUAL

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	2255A2300X	Athletic Trainer		NY

General Provider Information

NPI Number	:	1720940232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYA MANGUAL

Provider Business Mailing Address
First Line	:	634 STANTON AVE
Second Line	:
City	:	NORTH BALDWIN
State	:	NY
Zip	:	11510-1731
Country	:	US
Telephone Number	:	516-660-4151
Fax Number	:

Provider Business Practice Location Address
First Line	:	634 STANTON AVE
Second Line	:
City	:	NORTH BALDWIN
State	:	NY
Zip	:	11510-1731
Country	:	US
Telephone Number	:	516-660-4151
Fax Number	:

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

Provider Enumeration Date	:	12/02/2025
Last Update Date	:	12/02/2025

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Directions to “ MAYA MANGUAL ” Practice Location

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