Healthcare Provider Details

I. General information

NPI: 1902736523
Provider Name (Legal Business Name): LISA-DAWN MALONEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2026
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FIU DEPT OF NURSE ANESTHESIOLOGY MODESTO MADIQUE CAMPUS AHC 3, ROOM 342 11200 SW 8 STREET
MIAMI FL
33199-0001
US

IV. Provider business mailing address

8390 PHOENICIAN CT
DAVIE FL
33328-4413
US

V. Phone/Fax

Practice location:
  • Phone: 305-348-7703
  • Fax:
Mailing address:
  • Phone: 954-655-7983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: