Provider Demographics
NPI:1720131113
Name:IYER, MALA (MD)
Entity Type:Individual
Prefix:
First Name:MALA
Middle Name:
Last Name:IYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 SW ARCHER RD # 100256
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0256
Mailing Address - Country:US
Mailing Address - Phone:352-265-4357
Mailing Address - Fax:352-392-3614
Practice Address - Street 1:1600 SW ARCHER RD # 100256
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610
Practice Address - Country:US
Practice Address - Phone:352-265-4357
Practice Address - Fax:352-392-3614
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1356242084P0800X
NY1648212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024807100Medicaid
NY01797933Medicaid
NY56M431Medicare PIN