Provider Demographics
NPI:1558943647
Name:FAISON-MALLOY, JEAN (NCMA)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:
Last Name:FAISON-MALLOY
Suffix:
Gender:F
Credentials:NCMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 EAST ST
Mailing Address - Street 2:
Mailing Address - City:HARRINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19952-3374
Mailing Address - Country:US
Mailing Address - Phone:302-382-5409
Mailing Address - Fax:
Practice Address - Street 1:115 EAST ST
Practice Address - Street 2:
Practice Address - City:HARRINGTON
Practice Address - State:DE
Practice Address - Zip Code:19952-3374
Practice Address - Country:US
Practice Address - Phone:302-382-5409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy