Provider Demographics
NPI:1548649825
Name:ALDUNCIN, MAYDEL (COTA)
Entity type:Individual
Prefix:MS
First Name:MAYDEL
Middle Name:
Last Name:ALDUNCIN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1153 SW 138TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-2750
Mailing Address - Country:US
Mailing Address - Phone:786-327-9700
Mailing Address - Fax:305-229-9072
Practice Address - Street 1:1153 SW 138TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-2750
Practice Address - Country:US
Practice Address - Phone:786-327-9700
Practice Address - Fax:305-229-9072
Is Sole Proprietor?:No
Enumeration Date:2015-05-20
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA12787224Z00000X
FLPA9115096363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant