MEDICARE: DR. MIRANDA CARINA MALDONADO DNP, MSN

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	163W00000X	Registered Nurse	26NR22320100	NJ
2	163W00000X	Registered Nurse	803946	NY
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	404269	NY
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	26NJ15273700	NJ

General Provider Information

NPI Number	:	1568197606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIRANDA CARINA MALDONADO DNP, MSN

Provider Business Mailing Address
First Line	:	210 RIVER ST STE 24
Second Line	:
City	:	HACKENSACK
State	:	NJ
Zip	:	07601-7504
Country	:	US
Telephone Number	:	551-298-6971
Fax Number	:

Provider Business Practice Location Address
First Line	:	63 NEW MAIN ST STE 100
Second Line	:
City	:	HAVERSTRAW
State	:	NY
Zip	:	10927-1859
Country	:	US
Telephone Number	:	845-259-6881
Fax Number	:	201-648-2667

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

Provider Enumeration Date	:	07/22/2022
Last Update Date	:	10/01/2025

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