Provider Demographics
NPI:1902441884
Name:MALDONADO, GLADYS MARIA
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:MARIA
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 KEYSTONE AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:PECKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18452-1639
Mailing Address - Country:US
Mailing Address - Phone:570-766-4743
Mailing Address - Fax:
Practice Address - Street 1:555 KEYSTONE AVE APT 2
Practice Address - Street 2:
Practice Address - City:PECKVILLE
Practice Address - State:PA
Practice Address - Zip Code:18452-1639
Practice Address - Country:US
Practice Address - Phone:570-766-4743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide