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General NPI Number Information
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NPI Number | 1689836264
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Entity Type | Individual
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Provider Name | CIANA TYIESH HAYES MAXWELL M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/25/2008
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Last Update Date | 03/07/2019
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Provider Practice Location Address
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Address Line | 5045 ROUTE 130 STE F
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City | DELRAN
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State | NJ
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Zip | 08075-9707
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Country | US
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Telephone | 856-461-1717
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Fax |
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Provider Business Mailing Address
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Address Line | 2142 HARBOUR DR
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City | PALMYRA
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State | NJ
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Zip | 08065-1121
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Country | US
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Telephone |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MT193245
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 25MA08975900
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License Number State | NJ
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