Provider Demographics
NPI:1083451884
Name:MALONE, SHIRLEY
Entity type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:
Last Name:MALONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-0024
Mailing Address - Country:US
Mailing Address - Phone:726-203-0621
Mailing Address - Fax:210-257-6784
Practice Address - Street 1:6342 CANDLEVIEW CT
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78244-1953
Practice Address - Country:US
Practice Address - Phone:210-233-6084
Practice Address - Fax:210-257-6784
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-10
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372600000X, 3747A0650X, 3747P1801X, 376J00000X
TX023024253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No372600000XNursing Service Related ProvidersAdult Companion
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker