Individual
MRS. THERESA VALDEZ MALONE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2095 HENRY TECKLENBURG DR, CHARLESTON, SC 29414-5733
(843) 402-1037
(843) 402-1295
Mailing address
PO BOX 602645, CHARLOTTE, NC 28260-2645
(843) 789-1620
(843) 724-2454
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
992
SC
363A00000X
Physician Assistant
A992
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0737PA
—
SC
Enumeration date
11/07/2006
Last updated
11/28/2020
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