=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588457360
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAIYA GUILLORY CNM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2025
-----------------------------------------------------
Last Update Date | 05/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 760 BROADWAY
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11206-5317
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-963-7906
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 119 PAYSON AVE APT 2D
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10034-2712
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-366-8685
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 176B00000X
-----------------------------------------------------
Taxonomy Name | Midwife
-----------------------------------------------------
License Number | 002393
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------