Provider Demographics
NPI:1669492047
Name:MAGUNDAYAO, MINDA B (MD)
Entity type:Individual
Prefix:
First Name:MINDA
Middle Name:B
Last Name:MAGUNDAYAO
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 1:6701 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19126-2837
Mailing Address - Country:US
Mailing Address - Phone:215-276-3922
Mailing Address - Fax:215-276-8199
Practice Address - Street 1:6701 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19126-2837
Practice Address - Country:US
Practice Address - Phone:215-276-3922
Practice Address - Fax:215-276-8199
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033449E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist