Healthcare Provider Details

I. General information

NPI: 1356081889
Provider Name (Legal Business Name): MARISSA CELINE MALDONADO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1259 S PINELLAS AVE
TARPON SPRINGS FL
34689-3719
US

IV. Provider business mailing address

1259 S PINELLAS AVE
TARPON SPRINGS FL
34689-3719
US

V. Phone/Fax

Practice location:
  • Phone: 727-938-1908
  • Fax: 727-938-8693
Mailing address:
  • Phone: 727-938-1908
  • Fax: 727-938-8693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME171482
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: