Provider Demographics
NPI:1568296861
Name:REGULAR, MALIYAH
Entity type:Individual
Prefix:
First Name:MALIYAH
Middle Name:
Last Name:REGULAR
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 1:825 GEORGES RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-3357
Mailing Address - Country:US
Mailing Address - Phone:917-801-7015
Mailing Address - Fax:
Practice Address - Street 1:1109 S ROCK RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-3317
Practice Address - Country:US
Practice Address - Phone:917-801-7015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician