Provider Demographics
NPI:1093501843
Name:FERNANDEZ, MALIA SADE
Entity type:Individual
Prefix:
First Name:MALIA
Middle Name:SADE
Last Name:FERNANDEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 PATTERSON VILLAGE DR APT 1
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45419-4241
Mailing Address - Country:US
Mailing Address - Phone:937-432-7233
Mailing Address - Fax:
Practice Address - Street 1:102 PATTERSON VILLAGE DR APT 1
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45419-4241
Practice Address - Country:US
Practice Address - Phone:937-432-7233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care