MEDICARE: MS. SHIRLEY MALONE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	372600000X	Adult Companion
2	3747A0650X	Attendant Care Provider
3	3747P1801X	Personal Care Attendant
4	376J00000X	Homemaker
5	253Z00000X	In Home Supportive Care Agency	023024	TX

General Provider Information

NPI Number	:	1083451884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHIRLEY MALONE

Provider Business Mailing Address
First Line	:	PO BOX 24
Second Line	:
City	:	CONVERSE
State	:	TX
Zip	:	78109-0024
Country	:	US
Telephone Number	:	726-203-0621
Fax Number	:	210-257-6784

Provider Business Practice Location Address
First Line	:	6342 CANDLEVIEW CT
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78244-1953
Country	:	US
Telephone Number	:	210-233-6084
Fax Number	:	210-257-6784

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2024
Last Update Date	:	02/11/2025

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Directions to “ MS. SHIRLEY MALONE ” Practice Location

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