Provider Demographics
NPI:1043800782
Name:MALONE, SHA'KANDACE
Entity Type:Individual
Prefix:
First Name:SHA'KANDACE
Middle Name:
Last Name:MALONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7135 PEARSON RD UNIT 12
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32526-3679
Mailing Address - Country:US
Mailing Address - Phone:850-292-9450
Mailing Address - Fax:
Practice Address - Street 1:7135 PEARSON RD UNIT 12
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32526-3679
Practice Address - Country:US
Practice Address - Phone:850-292-9450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist