Provider Demographics
NPI:1396415626
Name:CYRUS, MALAIKA
Entity Type:Individual
Prefix:
First Name:MALAIKA
Middle Name:
Last Name:CYRUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14556 229TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11413-3923
Mailing Address - Country:US
Mailing Address - Phone:718-210-2163
Mailing Address - Fax:718-949-6315
Practice Address - Street 1:14556 229TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11413-3923
Practice Address - Country:US
Practice Address - Phone:718-210-2163
Practice Address - Fax:718-949-6315
Is Sole Proprietor?:No
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator