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General NPI Number Information
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NPI Number | 1649630468
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Entity Type | Individual
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Provider Name | MAHA MOSES FPMHNP
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Gender | Female
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Dates
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Enumeration Date | 03/07/2016
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Last Update Date | 07/08/2026
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Provider Practice Location Address
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Address Line | 1045 JAMES ST
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City | SYRACUSE
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State | NY
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Zip | 13203-2730
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Country | US
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Telephone | 153-472-4471
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Fax | 315-472-1759
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Provider Business Mailing Address
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Address Line | 4927 W GENESEE ST
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City | CAMILLUS
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State | NY
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Zip | 13031-2324
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Country | US
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Telephone | 315-996-0204
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 709158
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 405929
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License Number State | NY
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