Provider Demographics
NPI:1629813480
Name:MALLOY, EVA CALABIO (NURSE)
Entity type:Individual
Prefix:MS
First Name:EVA
Middle Name:CALABIO
Last Name:MALLOY
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:MS
Other - First Name:EVA
Other - Middle Name:CALABIO
Other - Last Name:PLANOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:96 BUTLER BLVD
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-2506
Mailing Address - Country:US
Mailing Address - Phone:516-302-3779
Mailing Address - Fax:
Practice Address - Street 1:96 BUTLER BLVD
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-2506
Practice Address - Country:US
Practice Address - Phone:516-302-3779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY611672163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse