Individual
TY MAULDIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1316 W WICKLOW CT, SIOUX FALLS, SD 57108-3252
(605) 836-1227
Mailing address
1316 W WICKLOW CT, SIOUX FALLS, SD 57108-3252
(605) 836-1227
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5020425893002
SS NETWORK ALLIANCE #
TN
01
—
96440
ACCME (ACCREDITATION COUNCIL FOR CONTINUING MEDICAL EDUCATION)
CA
Enumeration date
01/08/2022
Last updated
08/12/2025
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