Provider Demographics
NPI:1528314069
Name:MALOY, SUSAN ANN (MSED)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANN
Last Name:MALOY
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:SUE ANN
Other - Middle Name:
Other - Last Name:MALOY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:230 WASHINGTON AVENUE EXT
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-5390
Mailing Address - Country:US
Mailing Address - Phone:518-456-3268
Mailing Address - Fax:518-464-1469
Practice Address - Street 1:127 BLOOMINGROVE DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-8404
Practice Address - Country:US
Practice Address - Phone:518-283-4921
Practice Address - Fax:518-687-0375
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY252Y00000XOtherEARLY INTERVENTION