Individual
SHANIKA MALCOLM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2522 S BELLFORD ST, PHILADELPHIA, PA 19153-1411
(126) 726-6132
Mailing address
2522 S BELLFORD ST, PHILADELPHIA, PA 19153-1411
(126) 726-6132
Taxonomy
Speciality
Code
Description
License number
State
174H00000X
Health Educator
—
—
174N00000X
Lactation Consultant (Non-RN)
—
—
251J00000X
Nursing Care Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
374J00000X
Doula
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
32762349
DL
PA
Enumeration date
07/05/2018
Last updated
07/05/2018
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