Provider Demographics
NPI:1366282048
Name:MALEK, MITRA TERESA (PA-C)
Entity type:Individual
Prefix:MS
First Name:MITRA
Middle Name:TERESA
Last Name:MALEK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14011 NE 85TH CT
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-6411
Mailing Address - Country:US
Mailing Address - Phone:425-283-3062
Mailing Address - Fax:
Practice Address - Street 1:14011 NE 85TH CT
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-6411
Practice Address - Country:US
Practice Address - Phone:425-283-3062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant