Provider Demographics
NPI:1639683139
Name:MALONE, MARIA (CLC)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:MALONE
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1868 TULLAGEE AVE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-6037
Mailing Address - Country:US
Mailing Address - Phone:347-725-6426
Mailing Address - Fax:
Practice Address - Street 1:1868 TULLAGEE AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-6037
Practice Address - Country:US
Practice Address - Phone:347-725-6426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN