Provider Demographics
NPI:1619462595
Name:MALMENDIER, FIONA MARY
Entity Type:Individual
Prefix:MRS
First Name:FIONA
Middle Name:MARY
Last Name:MALMENDIER
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 1:14 BRADT RD
Mailing Address - Street 2:
Mailing Address - City:REXFORD
Mailing Address - State:NY
Mailing Address - Zip Code:12148-1103
Mailing Address - Country:US
Mailing Address - Phone:518-225-3438
Mailing Address - Fax:
Practice Address - Street 1:14 BRADT RD
Practice Address - Street 2:
Practice Address - City:REXFORD
Practice Address - State:NY
Practice Address - Zip Code:12148-1103
Practice Address - Country:US
Practice Address - Phone:518-225-3438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-24
Last Update Date:2018-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF342986363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily