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General NPI Number Information
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NPI Number | 1821781253
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Entity Type | Individual
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Provider Name | TYLER MALDONADO
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Gender | Female
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Dates
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Enumeration Date | 05/31/2023
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Last Update Date | 05/31/2023
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Provider Practice Location Address
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Address Line | 410 LAKEVILLE RD STE 212
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City | NEW HYDE PARK
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State | NY
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Zip | 11042-1122
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Country | US
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Telephone | 718-470-4198
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Fax |
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Provider Business Mailing Address
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Address Line | 16015 POWELLS COVE BLVD APT B204
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City | BEECHHURST
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State | NY
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Zip | 11357-1304
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Country | US
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Telephone | 646-265-7668
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F349526-01
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License Number State | NY
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