Provider Demographics
NPI:1255728374
Name:LYON, MALINDA JAY (DO)
Entity type:Individual
Prefix:DR
First Name:MALINDA
Middle Name:JAY
Last Name:LYON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MALINDA
Other - Middle Name:JAY
Other - Last Name:SCHRENK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8150 SHORE DRIVE
Mailing Address - Street 2:#522
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23518
Mailing Address - Country:US
Mailing Address - Phone:303-335-8954
Mailing Address - Fax:
Practice Address - Street 1:8150 SHORE DRIVE
Practice Address - Street 2:#522
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23518
Practice Address - Country:US
Practice Address - Phone:303-335-8954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-16
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102206155208600000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program