Healthcare Provider Details

I. General information

NPI: 1326003732
Provider Name (Legal Business Name): NEIL EDWIN MALDONADO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 8TH ST N
NAPLES FL
34102-5519
US

IV. Provider business mailing address

400 8TH ST N
NAPLES FL
34102-5519
US

V. Phone/Fax

Practice location:
  • Phone: 239-649-3333
  • Fax: 833-449-4347
Mailing address:
  • Phone: 239-649-3333
  • Fax: 833-449-4347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME125555
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: