Provider Demographics
NPI:1568886521
Name:MALDONADO, LYNDA (PA)
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LYNDA
Other - Middle Name:
Other - Last Name:AMILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:410 JACKTOWN RD
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:PA
Mailing Address - Zip Code:18013-9553
Mailing Address - Country:US
Mailing Address - Phone:646-369-8735
Mailing Address - Fax:
Practice Address - Street 1:525 E 68TH ST # 130
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-4870
Practice Address - Country:US
Practice Address - Phone:212-746-4209
Practice Address - Fax:212-746-8861
Is Sole Proprietor?:No
Enumeration Date:2014-02-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016788-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical