Provider Demographics
NPI:1992029953
Name:MALONE, SHANIQUE (MPAS, PA-C)
Entity Type:Individual
Prefix:MS
First Name:SHANIQUE
Middle Name:
Last Name:MALONE
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 W SAM HOUSTON PKWY N STE 220
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77041-8224
Mailing Address - Country:US
Mailing Address - Phone:713-402-7824
Mailing Address - Fax:713-570-0196
Practice Address - Street 1:4700 W SAM HOUSTON PKWY N STE 220
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77041-8224
Practice Address - Country:US
Practice Address - Phone:713-402-7824
Practice Address - Fax:713-570-0196
Is Sole Proprietor?:No
Enumeration Date:2010-03-19
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06485363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant