Provider Demographics
NPI:1437521721
Name:O'MALLEY, JADA MCDONALD (CFM)
Entity Type:Individual
Prefix:
First Name:JADA
Middle Name:MCDONALD
Last Name:O'MALLEY
Suffix:
Gender:F
Credentials:CFM
Other - Prefix:
Other - First Name:JADA
Other - Middle Name:
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CFM
Mailing Address - Street 1:1140 SHIPYARD BLVD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-6439
Mailing Address - Country:US
Mailing Address - Phone:910-332-0179
Mailing Address - Fax:910-332-0671
Practice Address - Street 1:1140 SHIPYARD BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-6439
Practice Address - Country:US
Practice Address - Phone:910-332-0179
Practice Address - Fax:910-332-0671
Is Sole Proprietor?:No
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCFM02960224900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy Fitter