Provider Demographics
NPI:1417548181
Name:MALYAK, ANNA ALEXANDRA (NP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:ALEXANDRA
Last Name:MALYAK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 AUBURN ST APT 1
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-3902
Mailing Address - Country:US
Mailing Address - Phone:781-752-8240
Mailing Address - Fax:
Practice Address - Street 1:77 HERRICK ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-2734
Practice Address - Country:US
Practice Address - Phone:978-927-4110
Practice Address - Fax:978-232-7057
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2312470363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily