Provider Demographics
NPI:1619165743
Name:LONGLEY, MALIENA MICHI (MD)
Entity Type:Individual
Prefix:
First Name:MALIENA
Middle Name:MICHI
Last Name:LONGLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MALIENA
Other - Middle Name:MICHI
Other - Last Name:DOWD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5804 CRUISER WAY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-4215
Mailing Address - Country:US
Mailing Address - Phone:813-494-4545
Mailing Address - Fax:
Practice Address - Street 1:14105 MCCORMICK DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-3019
Practice Address - Country:US
Practice Address - Phone:813-873-1177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT73221207K00000X
FLME102587207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology