Healthcare Provider Details

I. General information

NPI: 1528485935
Provider Name (Legal Business Name): MARIBEL VILLANUEVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2014
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7038 PARSONS BLVD APT 3D
FRESH MEADOWS NY
11365-3018
US

IV. Provider business mailing address

7038 PARSONS BLVD APT 3D
FRESH MEADOWS NY
11365-3018
US

V. Phone/Fax

Practice location:
  • Phone: 347-581-1982
  • Fax:
Mailing address:
  • Phone: 347-581-1982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number2073729261
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2073729261
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: