Provider Demographics
NPI:1851273163
Name:MALONEY, AMANDA DESIREE
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:DESIREE
Last Name:MALONEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MANDY
Other - Middle Name:DESIREE
Other - Last Name:MALONEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14400 BOGERT PKWY
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-2652
Mailing Address - Country:US
Mailing Address - Phone:918-714-9064
Mailing Address - Fax:
Practice Address - Street 1:14400 BOGERT PKWY
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-2652
Practice Address - Country:US
Practice Address - Phone:918-714-9064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-25
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist