Provider Demographics
NPI:1659198885
Name:MALAKAN, DEBORA
Entity type:Individual
Prefix:
First Name:DEBORA
Middle Name:
Last Name:MALAKAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEBBIE
Other - Middle Name:
Other - Last Name:MALAKAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14428 69TH RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1702
Mailing Address - Country:US
Mailing Address - Phone:347-692-6810
Mailing Address - Fax:
Practice Address - Street 1:14428 69TH RD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1702
Practice Address - Country:US
Practice Address - Phone:347-692-6810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered