Healthcare Provider Details

I. General information

NPI: 1245043439
Provider Name (Legal Business Name): MALIKA SADIYAH MCCOY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2025
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 E MISSOURI AVE
PHOENIX AZ
85014-2405
US

IV. Provider business mailing address

1420 E MISSOURI AVE
PHOENIX AZ
85014-2405
US

V. Phone/Fax

Practice location:
  • Phone: 602-758-2851
  • Fax:
Mailing address:
  • Phone: 480-860-2345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number329017
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: