Provider Demographics
NPI:1467947473
Name:MALICK, FARYAL SHAHAB (MD)
Entity Type:Individual
Prefix:DR
First Name:FARYAL
Middle Name:SHAHAB
Last Name:MALICK
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 1:2100 STANTONSBURG ROAD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834
Mailing Address - Country:US
Mailing Address - Phone:252-847-2658
Mailing Address - Fax:252-847-8304
Practice Address - Street 1:2100 STANTONSBURG ROAD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834
Practice Address - Country:US
Practice Address - Phone:252-847-2658
Practice Address - Fax:252-847-8304
Is Sole Proprietor?:No
Enumeration Date:2018-06-22
Last Update Date:2022-08-19
Deactivation Date:2019-06-26
Deactivation Code:
Reactivation Date:2019-07-03
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
VA0116033420390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program