Provider Demographics
NPI:1144057258
Name:MALLOY, TIFFNEY A (TOD/HI)
Entity type:Individual
Prefix:
First Name:TIFFNEY
Middle Name:A
Last Name:MALLOY
Suffix:
Gender:F
Credentials:TOD/HI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:NY
Mailing Address - Zip Code:14591-9708
Mailing Address - Country:US
Mailing Address - Phone:585-664-4415
Mailing Address - Fax:
Practice Address - Street 1:6 MAIN ST
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:NY
Practice Address - Zip Code:14591-9702
Practice Address - Country:US
Practice Address - Phone:585-763-1019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-14
Last Update Date:2024-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist