Individual
MS. DALIA MAXWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
14 GIBSON BLVD, VALLEY STREAM, NY 11581-2020
(347) 204-3608
(516) 561-1274
Mailing address
14 GIBSON BLVD, VALLEY STREAM, NY 11581-2020
(347) 204-3608
(516) 561-1274
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1588926737
INDIVIDUAL SERVICE PROVIDER
NY
Enumeration date
06/13/2012
Last updated
06/14/2012
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