Healthcare Provider Details

I. General information

NPI: 1225967920
Provider Name (Legal Business Name): ANNA MAIDA
Entity Type: Individual
Gender:
Sole Proprietor: Y

Provider Other Name: KESTIN MAIDA

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8521 SIX FORKS RD STE 350
RALEIGH NC
27615-5863
US

IV. Provider business mailing address

4708 DILLINGHAM CT
RALEIGH NC
27604-4738
US

V. Phone/Fax

Practice location:
  • Phone: 919-676-3118
  • Fax:
Mailing address:
  • Phone: 252-268-7018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: