Provider Demographics
NPI:1073267597
Name:MALAVITE, LEILA MARIE (DAC, LAC)
Entity type:Individual
Prefix:DR
First Name:LEILA
Middle Name:MARIE
Last Name:MALAVITE
Suffix:
Gender:F
Credentials:DAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5024 DORSEY HALL DR STE 202B
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-7869
Mailing Address - Country:US
Mailing Address - Phone:330-415-2238
Mailing Address - Fax:
Practice Address - Street 1:5024 DORSEY HALL DR STE 202B
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7869
Practice Address - Country:US
Practice Address - Phone:330-415-2238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-04
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02872171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist