Provider Demographics
NPI:1770724148
Name:MALAKA, SHAUNN DOMINIQUE (DPM)
Entity type:Individual
Prefix:
First Name:SHAUNN
Middle Name:DOMINIQUE
Last Name:MALAKA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14904 JEFFERSON DAVIS HWY
Mailing Address - Street 2:STE 105
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3908
Mailing Address - Country:US
Mailing Address - Phone:703-490-8171
Mailing Address - Fax:703-490-8172
Practice Address - Street 1:14904 JEFFERSON DAVIS HWY
Practice Address - Street 2:STE 105
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3908
Practice Address - Country:US
Practice Address - Phone:703-490-8171
Practice Address - Fax:703-490-8172
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO684213ES0103X
MD01481213ES0103X
DCPO1000072213ES0103X
VA0103301025213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery