Healthcare Provider Details

I. General information

NPI: 1477046357
Provider Name (Legal Business Name): MAYA ANTONY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 07/23/2021
Certification Date: 06/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SE HOSPITAL AVE # 2346
STUART FL
34994-2346
US

IV. Provider business mailing address

3007 WHITEWING AVE
EDINBURG TX
78539-3456
US

V. Phone/Fax

Practice location:
  • Phone: 772-287-5200
  • Fax:
Mailing address:
  • Phone: 956-720-2204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME151416
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME151416
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: