Provider Demographics
NPI:1811587728
Name:MALLOY, DAYRON EBRO
Entity Type:Individual
Prefix:
First Name:DAYRON
Middle Name:EBRO
Last Name:MALLOY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 JEANETTE DR
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:PA
Mailing Address - Zip Code:15147-1536
Mailing Address - Country:US
Mailing Address - Phone:724-732-2428
Mailing Address - Fax:
Practice Address - Street 1:125 JEANETTE DR
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:PA
Practice Address - Zip Code:15147-1536
Practice Address - Country:US
Practice Address - Phone:724-732-2428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide