Healthcare Provider Details

I. General information

NPI: 1962048751
Provider Name (Legal Business Name): MAYDELIS SUAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2019
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21223 BROOKWOOD CRESCENT DR
KATY TX
77449-2849
US

IV. Provider business mailing address

21223 BROOKWOOD CRESCENT DR
KATY TX
77449-2849
US

V. Phone/Fax

Practice location:
  • Phone: 386-205-4365
  • Fax:
Mailing address:
  • Phone: 386-205-4365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1105207
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number979574
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: