Provider Demographics
NPI:1295697498
Name:MYMAE GROUP LLC
Entity type:Organization
Organization Name:MYMAE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TORI
Authorized Official - Middle Name:CIDICIQUA
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-350-0334
Mailing Address - Street 1:317 TROLLINGER ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-2227
Mailing Address - Country:US
Mailing Address - Phone:336-270-4684
Mailing Address - Fax:
Practice Address - Street 1:317 TROLLINGER ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-2227
Practice Address - Country:US
Practice Address - Phone:336-270-4684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-26
Last Update Date:2025-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty