Provider Demographics
NPI:1245232271
Name:MALONEY, SHIRLEY A (PT)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:A
Last Name:MALONEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 NEW KARNER RD
Mailing Address - Street 2:ROSEWOOD PLAZA
Mailing Address - City:COLONIE
Mailing Address - State:NY
Mailing Address - Zip Code:12205-3882
Mailing Address - Country:US
Mailing Address - Phone:518-869-2429
Mailing Address - Fax:518-869-5939
Practice Address - Street 1:501 NEW KARNER RD
Practice Address - Street 2:ROSEWOOD PLAZA
Practice Address - City:COLONIE
Practice Address - State:NY
Practice Address - Zip Code:12205-3882
Practice Address - Country:US
Practice Address - Phone:518-869-2429
Practice Address - Fax:518-869-5939
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003930-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01699554Medicaid
NY01699554Medicaid