Provider Demographics
NPI:1902063837
Name:VAYSBROT, MAYA (DO)
Entity Type:Individual
Prefix:MRS
First Name:MAYA
Middle Name:
Last Name:VAYSBROT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20325 N. 51ST. AVE.
Mailing Address - Street 2:SUITE 160
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-4622
Mailing Address - Country:US
Mailing Address - Phone:623-466-6350
Mailing Address - Fax:602-358-8698
Practice Address - Street 1:20325 N. 51ST. AVE.
Practice Address - Street 2:SUITE 160
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-4622
Practice Address - Country:US
Practice Address - Phone:623-466-6350
Practice Address - Fax:602-358-8698
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2401112084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology