Provider Demographics
NPI:1710209812
Name:MALLOY, BARBARA DIANE (RN)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:DIANE
Last Name:MALLOY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6838 MINUTEMAN TRL
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:NY
Mailing Address - Zip Code:14047-9576
Mailing Address - Country:US
Mailing Address - Phone:716-947-4403
Mailing Address - Fax:
Practice Address - Street 1:3409 GENESEE ST
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-5051
Practice Address - Country:US
Practice Address - Phone:716-855-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY496257-1163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health