Individual
MAYA NIEWIADOMSKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
6919 N DALE MABRY HWY STE 200, TAMPA, FL 33614-3972
(813) 933-3324
(813) 932-4357
Mailing address
6919 N DALE MABRY HWY STE 200, TAMPA, FL 33614-3972
(813) 933-3324
(813) 932-4357
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA9110312
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
020773500
—
FL
01
—
IGSDY
BLUE CROSS BLUE SHIELD
FL
Enumeration date
04/06/2017
Last updated
10/19/2022
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