Provider Demographics
NPI:1174358311
Name:WEAVER, MAYA ELYSE (MS)
Entity type:Individual
Prefix:MS
First Name:MAYA
Middle Name:ELYSE
Last Name:WEAVER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 BRANCH TPKE UNIT 117
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-5780
Mailing Address - Country:US
Mailing Address - Phone:210-744-6251
Mailing Address - Fax:
Practice Address - Street 1:35 NEWPORT RD
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:NH
Practice Address - Zip Code:03257-5413
Practice Address - Country:US
Practice Address - Phone:603-865-1321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program