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General NPI Number Information
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NPI Number | 1669974804
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Entity Type | Individual
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Provider Name | MYSHANDA MALDONADO
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Gender | Female
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Dates
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Enumeration Date | 03/04/2018
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Last Update Date | 10/23/2018
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Provider Practice Location Address
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Address Line | 725 N 12TH AVE
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City | ARCADIA
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State | FL
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Zip | 34266-8752
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Country | US
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Telephone | 863-494-1242
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Fax | 863-491-0466
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Provider Business Mailing Address
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Address Line | 700 8TH AVE W STE 101
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City | PALMETTO
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State | FL
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Zip | 34221-4737
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Country | US
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Telephone | 941-776-4000
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Fax | 941-845-4963
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW15142
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License Number State | FL
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