Provider Demographics
NPI:1205551876
Name:MALOY, SHAMEQUA (LVN)
Entity type:Individual
Prefix:
First Name:SHAMEQUA
Middle Name:
Last Name:MALOY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2062 N BULLIS RD
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90221-1258
Mailing Address - Country:US
Mailing Address - Phone:323-816-3780
Mailing Address - Fax:
Practice Address - Street 1:2062 N BULLIS RD
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-1258
Practice Address - Country:US
Practice Address - Phone:323-816-3780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA221356164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse