Healthcare Provider Details

I. General information

NPI: 1770599987
Provider Name (Legal Business Name): JUDITH MAYES APRN, BC,MAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 CHATHAM PL
WHITE PLAINS NY
10605-3711
US

IV. Provider business mailing address

15 CHATHAM PL
WHITE PLAINS NY
10605-3711
US

V. Phone/Fax

Practice location:
  • Phone: 914-946-3364
  • Fax: 914-946-3364
Mailing address:
  • Phone: 914-946-3364
  • Fax: 914-946-3364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number247415-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: