Provider Demographics
NPI:1255749800
Name:DALTON, MALANA SHEA (CSFA)
Entity type:Individual
Prefix:
First Name:MALANA
Middle Name:SHEA
Last Name:DALTON
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 MADISON OAK DR STE 610
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3924
Mailing Address - Country:US
Mailing Address - Phone:210-496-2222
Mailing Address - Fax:
Practice Address - Street 1:540 MADISON OAK DR STE 610
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3924
Practice Address - Country:US
Practice Address - Phone:210-496-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-28
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical