Provider Demographics
NPI:1073658332
Name:PROPHET, MALSHUNDRIA (MD)
Entity Type:Individual
Prefix:
First Name:MALSHUNDRIA
Middle Name:
Last Name:PROPHET
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 1:166 STONERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-8239
Mailing Address - Country:US
Mailing Address - Phone:803-461-3049
Mailing Address - Fax:803-461-3428
Practice Address - Street 1:166 STONERIDGE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-8239
Practice Address - Country:US
Practice Address - Phone:803-461-3049
Practice Address - Fax:803-461-3428
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL39676207R00000X, 207RH0003X
SC39676207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine