Healthcare Provider Details

I. General information

NPI: 1699131243
Provider Name (Legal Business Name): CHRISTINA R. MALLOY PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINA PEYTON

II. Dates (important events)

Enumeration Date: 01/12/2016
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W 14TH ST STE 1E40
WILMINGTON DE
19801-1013
US

IV. Provider business mailing address

501 W 14TH ST STE 1E40
WILMINGTON DE
19801-1013
US

V. Phone/Fax

Practice location:
  • Phone: 302-320-2100
  • Fax: 302-320-2121
Mailing address:
  • Phone: 302-320-2100
  • Fax: 302-320-2121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberL8-0000140
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0037990
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: