Provider Demographics
NPI:1871198960
Name:MALDONADO, MAGDELYN (MD)
Entity type:Individual
Prefix:DR
First Name:MAGDELYN
Middle Name:
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12806 SOPHIAMARIE LOOP
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7182
Mailing Address - Country:US
Mailing Address - Phone:407-452-7655
Mailing Address - Fax:
Practice Address - Street 1:9920 EARLSTON ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-1860
Practice Address - Country:US
Practice Address - Phone:407-452-7655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTPME1146207Q00000X
NJNJDCATEMP-037226207Q00000X
FLTPPA672363AM0700X
PR864-P.A.363AM0700X
FLHSE36437208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical