Individual
DYLAN MALLOY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
11300 CRESTHILL DR STE 120, MINT HILL, NC 28227-7924
(704) 438-9479
(704) 438-9478
Mailing address
PO BOX 601843, CHARLOTTE, NC 28260-1843
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-09649
NC
363AM0700X
Medical Physician Assistant
—
CT
Other
Enumeration date
05/02/2016
Last updated
08/19/2021
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