Provider Demographics
NPI:1538194683
Name:MALIFF, SHARON DENISE (LPN)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:DENISE
Last Name:MALIFF
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:779 NOTRE DAME AVE
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-1957
Mailing Address - Country:US
Mailing Address - Phone:330-819-1045
Mailing Address - Fax:
Practice Address - Street 1:779 NOTRE DAME AVE
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-1957
Practice Address - Country:US
Practice Address - Phone:330-819-1045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN063075164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2174043Medicare ID - Type UnspecifiedPROVIDER NUMBER