Basic Information
| Provider Information | |||||||||
| NPI: | 1003000712 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MALLORY | ||||||||
| FirstName: | SHEILA | ||||||||
| MiddleName: | ORALLO | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | N. P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1867 E FIR AVE STE 104 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937203841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5593255876 | ||||||||
| FaxNumber: | 5593255838 | ||||||||
| Practice Location | |||||||||
| Address1: | 1867 E FIR AVE STE 104 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937203841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5593255876 | ||||||||
| FaxNumber: | 5593255838 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2007 | ||||||||
| LastUpdateDate: | 11/19/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 11495 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.