Healthcare Provider Details

I. General information

NPI: 1952622425
Provider Name (Legal Business Name): VIVIEN SANDRA MAYNARD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 BAINBRIDGE AVE
BRONX NY
10467-2403
US

IV. Provider business mailing address

301 BEDFORD AVE APT 1
MOUNT VERNON NY
10553-2018
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-4664
  • Fax: 718-405-5609
Mailing address:
  • Phone: 646-684-0547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number354340
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number618927
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: