Provider Demographics
NPI:1831822436
Name:MALLOY, TASIA MONIQUE (BD(DONA))
Entity type:Individual
Prefix:MRS
First Name:TASIA
Middle Name:MONIQUE
Last Name:MALLOY
Suffix:
Gender:F
Credentials:BD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3235 PLEASANT GARDEN RD APT 3C
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-4649
Mailing Address - Country:US
Mailing Address - Phone:412-819-7263
Mailing Address - Fax:
Practice Address - Street 1:3235 PLEASANT GARDEN RD APT 3C
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-4649
Practice Address - Country:US
Practice Address - Phone:412-819-7263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula