Provider Demographics
NPI:1619548021
Name:MALATAK, RYLIE JAE
Entity Type:Individual
Prefix:
First Name:RYLIE
Middle Name:JAE
Last Name:MALATAK
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 1:114 HEMLOCK CT
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15071-3054
Mailing Address - Country:US
Mailing Address - Phone:412-295-4084
Mailing Address - Fax:
Practice Address - Street 1:555 MARRIOTT DR STE 315
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-5088
Practice Address - Country:US
Practice Address - Phone:615-258-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist