Provider Demographics
NPI:1598559403
Name:MALONE, PHYLISIA FAWNTE
Entity type:Individual
Prefix:
First Name:PHYLISIA
Middle Name:FAWNTE
Last Name:MALONE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13226 BRANDYWINE RD
Mailing Address - Street 2:
Mailing Address - City:BRANDYWINE
Mailing Address - State:MD
Mailing Address - Zip Code:20613-5622
Mailing Address - Country:US
Mailing Address - Phone:832-301-2289
Mailing Address - Fax:
Practice Address - Street 1:6911 LAUREL BOWIE RD STE 309
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1712
Practice Address - Country:US
Practice Address - Phone:301-755-4021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician