Provider Demographics
NPI:1215036918
Name:NAYAK, MALA S (MD)
Entity Type:Individual
Prefix:DR
First Name:MALA
Middle Name:S
Last Name:NAYAK
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 1:206 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-1618
Mailing Address - Country:US
Mailing Address - Phone:650-617-8340
Mailing Address - Fax:650-321-5468
Practice Address - Street 1:206 CALIFORNIA AVE
Practice Address - Street 2:SERVICE TEAM ADULT CALIFORNIA
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1618
Practice Address - Country:US
Practice Address - Phone:650-617-8340
Practice Address - Fax:650-321-5468
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA552792084F0202X, 2084P0800X, 2084P0802X, 2084P0804X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A552791OtherPPIN
W31564Medicare UPIN
00A552791OtherPPIN