Provider Demographics
NPI:1770970774
Name:MALONE, CASSANDRA
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:MALONE
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 1:931 HIGHWAY 80 W UNIT 218D
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39204-3914
Mailing Address - Country:US
Mailing Address - Phone:601-321-9502
Mailing Address - Fax:601-321-9503
Practice Address - Street 1:931 HIGHWAY 80 W UNIT 218D
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-3914
Practice Address - Country:US
Practice Address - Phone:601-321-9502
Practice Address - Fax:601-321-9503
Is Sole Proprietor?:No
Enumeration Date:2015-04-17
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor