Provider Demographics
NPI:1194238196
Name:MALLETT, ALECIA MANDELA
Entity type:Individual
Prefix:MISS
First Name:ALECIA
Middle Name:MANDELA
Last Name:MALLETT
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 1:835NW168TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169
Mailing Address - Country:US
Mailing Address - Phone:786-356-5453
Mailing Address - Fax:
Practice Address - Street 1:835NW168TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-3316
Practice Address - Country:US
Practice Address - Phone:786-356-5453
Practice Address - Fax:786-356-5453
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
FL374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
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