Provider Demographics
NPI:1043959133
Name:MALLARY, SHANDRA PARTRELL
Entity Type:Individual
Prefix:
First Name:SHANDRA
Middle Name:PARTRELL
Last Name:MALLARY
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 1:1799 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-6621
Mailing Address - Country:US
Mailing Address - Phone:786-239-3081
Mailing Address - Fax:
Practice Address - Street 1:1799 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-6621
Practice Address - Country:US
Practice Address - Phone:786-239-3081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist