Healthcare Provider Details

I. General information

NPI: 1326424177
Provider Name (Legal Business Name): MAANYA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 MAIN ST
CADIZ KY
42211-9163
US

IV. Provider business mailing address

116 MAIN ST
CADIZ KY
42211-9163
US

V. Phone/Fax

Practice location:
  • Phone: 270-350-4504
  • Fax:
Mailing address:
  • Phone: 270-350-4504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number44458
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number42143
License Number StateKY

VIII. Authorized Official

Name: DR. HARSHUL PATEL
Title or Position: MEMBER
Credential: M.D.
Phone: 212-844-9916