Provider Demographics
NPI:1972256501
Name:MALVASI, GIANA MARIE
Entity type:Individual
Prefix:
First Name:GIANA
Middle Name:MARIE
Last Name:MALVASI
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 1:7629 MARKET ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-6051
Mailing Address - Country:US
Mailing Address - Phone:330-965-5050
Mailing Address - Fax:
Practice Address - Street 1:7629 MARKET ST STE 100
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-6051
Practice Address - Country:US
Practice Address - Phone:330-965-5050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-02
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.007287RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant