Provider Demographics
NPI:1720297799
Name:MALONE, TOYA VENETTA (MD)
Entity type:Individual
Prefix:DR
First Name:TOYA
Middle Name:VENETTA
Last Name:MALONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7730 W CHEYENNE AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-8412
Mailing Address - Country:US
Mailing Address - Phone:725-221-1568
Mailing Address - Fax:725-333-9218
Practice Address - Street 1:7730 W CHEYENNE AVE STE 107
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-8412
Practice Address - Country:US
Practice Address - Phone:725-221-1568
Practice Address - Fax:725-333-9218
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010880062084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1417961137OtherBCBSM - BRONSON
MI1720297799Medicaid
MIC96718290 - BRONSONMedicare PIN