Provider Demographics
NPI:1245403765
Name:BLAKEY, MALIKATA RAHIMA (MED)
Entity Type:Individual
Prefix:
First Name:MALIKATA
Middle Name:RAHIMA
Last Name:BLAKEY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2917 SNAPSWELL ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-7570
Mailing Address - Country:US
Mailing Address - Phone:252-573-9614
Mailing Address - Fax:
Practice Address - Street 1:2917 SNAPSWELL ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-7570
Practice Address - Country:US
Practice Address - Phone:252-573-9614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-04
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency