Provider Demographics
NPI:1609533272
Name:SUTHERLAND, MALICA
Entity Type:Individual
Prefix:
First Name:MALICA
Middle Name:
Last Name:SUTHERLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 844
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10528-0844
Mailing Address - Country:US
Mailing Address - Phone:914-689-1379
Mailing Address - Fax:888-600-0158
Practice Address - Street 1:214 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10528-4302
Practice Address - Country:US
Practice Address - Phone:914-689-1379
Practice Address - Fax:888-600-0158
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion