Provider Demographics
NPI:1073696449
Name:MALMAY, SHIRLEY ANN (LMT, NCBTMB)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:ANN
Last Name:MALMAY
Suffix:
Gender:F
Credentials:LMT, NCBTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 BERT KOUNS #11
Mailing Address - Street 2:INDUSTRIAL LOOP SUITE G
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-2900
Mailing Address - Country:US
Mailing Address - Phone:318-686-1186
Mailing Address - Fax:318-686-1053
Practice Address - Street 1:3110 BERT KOUNS #11 INDUSTRIAL LOOP SUITE G
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105
Practice Address - Country:US
Practice Address - Phone:318-865-6050
Practice Address - Fax:318-686-1053
Is Sole Proprietor?:No
Enumeration Date:2006-10-21
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA2861174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist