Provider Demographics
NPI:1649869397
Name:MUSSO, MALYKA
Entity type:Individual
Prefix:
First Name:MALYKA
Middle Name:
Last Name:MUSSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3384 SANDALWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-3559
Mailing Address - Country:US
Mailing Address - Phone:330-801-8297
Mailing Address - Fax:
Practice Address - Street 1:5583 ABBYSHIRE DR
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-2684
Practice Address - Country:US
Practice Address - Phone:330-329-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant