Individual
MRS. MARIA THITAVASANTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
8536 101ST ST, RICHMOND HILL, NY 11418-1111
(917) 238-2548
Mailing address
8536 101ST ST, RICHMOND HILL, NY 11418-1111
(917) 238-2548
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
327274
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
JUP26529V01
—
NY
Enumeration date
03/15/2017
Last updated
03/15/2017
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