Provider Demographics
NPI:1144890088
Name:PALAKAL, MAYA D
Entity type:Individual
Prefix:MRS
First Name:MAYA
Middle Name:D
Last Name:PALAKAL
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 1:14730 CROSSTON BAY CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824-4292
Mailing Address - Country:US
Mailing Address - Phone:407-601-8088
Mailing Address - Fax:
Practice Address - Street 1:14730 CROSSTON BAY CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32824-4292
Practice Address - Country:US
Practice Address - Phone:407-601-8088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11012187363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology