Provider Demographics
NPI:1427516954
Name:MALLAMO-JANSKI, CHAD
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:MALLAMO-JANSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1727 WALKER AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-3397
Mailing Address - Country:US
Mailing Address - Phone:916-317-7590
Mailing Address - Fax:
Practice Address - Street 1:136 COLEMAN BUILDING
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27402
Practice Address - Country:US
Practice Address - Phone:336-334-5925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer