Individual
ANASTASIA MALLORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6723 TOWPATH RD, EAST SYRACUSE, NY 13057-9506
(315) 425-1004
(315) 422-4855
Mailing address
6723 TOWPATH RD, EAST SYRACUSE, NY 13057-9506
(315) 425-1004
(315) 422-4855
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
1268331181
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3715422
NYS DEPT OF EDUCATION
NY
Enumeration date
09/06/2021
Last updated
09/06/2021
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