Provider Demographics
NPI:1720433394
Name:MENENDEZ, JIANA (MD)
Entity type:Individual
Prefix:DR
First Name:JIANA
Middle Name:
Last Name:MENENDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 BUCKNAM RD STE 2C
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1209
Mailing Address - Country:US
Mailing Address - Phone:207-781-1500
Mailing Address - Fax:
Practice Address - Street 1:5 BUCKNAM RD STE 2C
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1209
Practice Address - Country:US
Practice Address - Phone:207-781-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-02
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY299729207Q00000X
MEMD27550207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine