MEDICARE: AMANDA RACHAEL MAITLAND

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist		NY

General Provider Information

NPI Number	:	1356230957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA RACHAEL MAITLAND

Provider Business Mailing Address
First Line	:	641 E 84TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-3427
Country	:	US
Telephone Number	:	347-781-8878
Fax Number	:

Provider Business Practice Location Address
First Line	:	349 E 35TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-5001
Country	:	US
Telephone Number	:	917-801-9150
Fax Number	:	929-567-2881

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2025
Last Update Date	:	06/30/2025

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