Provider Demographics
NPI:1437440245
Name:MAYABB, FALLAN NICHOLE (MD)
Entity Type:Individual
Prefix:
First Name:FALLAN
Middle Name:NICHOLE
Last Name:MAYABB
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 1:1013 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-5043
Mailing Address - Country:US
Mailing Address - Phone:573-472-7535
Mailing Address - Fax:
Practice Address - Street 1:1013 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-5043
Practice Address - Country:US
Practice Address - Phone:573-472-7535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10039962207V00000X
MO2015013287207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology