Provider Demographics
NPI:1669537379
Name:MALUNDO, MOLLY MEGAN
Entity type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:MEGAN
Last Name:MALUNDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18316 KEY WEST CT
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-7315
Mailing Address - Country:US
Mailing Address - Phone:612-298-8286
Mailing Address - Fax:
Practice Address - Street 1:21135 JACQUARD AVE
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-6022
Practice Address - Country:US
Practice Address - Phone:952-232-3327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer