Provider Demographics
NPI:1114599263
Name:OMOWALE-MCQUILLER, MALAIKA (CNS, LDN)
Entity Type:Individual
Prefix:
First Name:MALAIKA
Middle Name:
Last Name:OMOWALE-MCQUILLER
Suffix:
Gender:F
Credentials:CNS, LDN
Other - Prefix:
Other - First Name:MALAIKA
Other - Middle Name:
Other - Last Name:OMOWALE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNS, LDN
Mailing Address - Street 1:364 E MAIN ST STE 1508
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-1482
Mailing Address - Country:US
Mailing Address - Phone:302-314-2950
Mailing Address - Fax:302-378-8087
Practice Address - Street 1:834 SWEET BIRCH DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-7873
Practice Address - Country:US
Practice Address - Phone:302-376-6901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEDN-0010857133N00000X, 133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133N00000XDietary & Nutritional Service ProvidersNutritionist