Provider Demographics
NPI:1073061214
Name:MALIK, SHAYNE LYNNE MANGALINDAN
Entity Type:Individual
Prefix:
First Name:SHAYNE LYNNE
Middle Name:MANGALINDAN
Last Name:MALIK
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 1:9765 SAN JOSE BLVD
Mailing Address - Street 2:STE. 102
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-4402
Mailing Address - Country:US
Mailing Address - Phone:904-260-5757
Mailing Address - Fax:904-268-0733
Practice Address - Street 1:9765 SAN JOSE BLVD
Practice Address - Street 2:STE. 102
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-4402
Practice Address - Country:US
Practice Address - Phone:904-260-5757
Practice Address - Fax:904-268-0733
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-16
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9372179363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily