Basic Information
Provider Information
NPI: 1003000712
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MALLORY
FirstName: SHEILA
MiddleName: ORALLO
NamePrefix: MS.
NameSuffix:  
Credential: N. P.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
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
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X11495CAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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