MEDICARE: MAYA LAPRADE DO

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	207Q00000X	Family Medicine Physician	UO7848	FL
2	208M00000X	Hospitalist Physician	1730758566	FL
3	207Q00000X	Family Medicine Physician	OS19365	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730758566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYA LAPRADE DO

Provider Business Mailing Address
First Line	:	125 FLORIDA MEMORIAL PKWY STE 2200
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-9309
Country	:	US
Telephone Number	:	386-409-6839
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 FLORIDA MEMORIAL PKWY STE 2200
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-9309
Country	:	US
Telephone Number	:	386-409-6839
Fax Number	:

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

Provider Enumeration Date	:	06/24/2021
Last Update Date	:	07/29/2024

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Directions to “ MAYA LAPRADE DO” Practice Location

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