Healthcare Provider Details

I. General information

NPI: 1922756907
Provider Name (Legal Business Name): SHEILA MALLENAHALLI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2022
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 SW 10TH ST APT 2107
MIAMI FL
33130-3689
US

IV. Provider business mailing address

117 SW 10TH ST APT 2107
MIAMI FL
33130-3689
US

V. Phone/Fax

Practice location:
  • Phone: 337-552-7789
  • Fax:
Mailing address:
  • Phone: 337-552-7789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME174162
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number351191
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: