Healthcare Provider Details

I. General information

NPI: 1306649454
Provider Name (Legal Business Name): MAYA MENON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 FAIRFAX AVE STE 206
NORFOLK VA
23507-1914
US

IV. Provider business mailing address

735 FAIRFAX AVE STE 1017C
NORFOLK VA
23507-2007
US

V. Phone/Fax

Practice location:
  • Phone: 757-446-0377
  • Fax:
Mailing address:
  • Phone: 757-446-6191
  • Fax: 757-446-6195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: