MEDICARE: AMANNI SHANAI MALLOY

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	106S00000X	Behavior Technician		GA

General Provider Information

NPI Number	:	1750214144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANNI SHANAI MALLOY

Provider Business Mailing Address
First Line	:	1500 WALTON RESERVE BLVD APT 5301
Second Line	:
City	:	AUSTELL
State	:	GA
Zip	:	30168-2518
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 DALLAS HWY SW # 202-1119
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30064-2567
Country	:	US
Telephone Number	:	678-672-0068
Fax Number	:

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

Provider Enumeration Date	:	06/04/2026
Last Update Date	:	06/04/2026

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Directions to “ AMANNI SHANAI MALLOY ” Practice Location

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