Healthcare Provider Details

I. General information

NPI: 1043127871
Provider Name (Legal Business Name): MALEAH WHITTEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 SPRING LAKE COVE LANE APT 107
FRUITLAND PARK FL
34731
US

IV. Provider business mailing address

1408 SPRING LAKE COVE LANE APT 107
FRUITLAND PARK FL
34731
US

V. Phone/Fax

Practice location:
  • Phone: 706-386-1021
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: