Provider Demographics
NPI:1902160070
Name:AL-MALT, MOIRA LEAH (RN)
Entity Type:Individual
Prefix:
First Name:MOIRA
Middle Name:LEAH
Last Name:AL-MALT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 E PRINCETON ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1456
Mailing Address - Country:US
Mailing Address - Phone:407-897-3737
Mailing Address - Fax:407-897-3711
Practice Address - Street 1:615 E PRINCETON ST
Practice Address - Street 2:SUITE 240
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1456
Practice Address - Country:US
Practice Address - Phone:407-897-3737
Practice Address - Fax:407-897-3711
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL3349732163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator