Individual
FARYAL J MALLICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
14003 N DALE MABRY HWY STE C, TAMPA, FL 33618-2459
(813) 461-7797
Mailing address
10006 CROSS CREEK BLVD STE 124, TAMPA, FL 33647-2595
(813) 461-7707
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
51944
KY
2084P0800X
Psychiatry Physician
TP944
KY
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
ME140149
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100572460
—
KY
Enumeration date
04/05/2016
Last updated
02/20/2025
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