Healthcare Provider Details

I. General information

NPI: 1417548181
Provider Name (Legal Business Name): ANNA ALEXANDRA MALYAK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2021
Last Update Date: 07/01/2022
Certification Date: 07/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 HERRICK ST
BEVERLY MA
01915-2734
US

IV. Provider business mailing address

6 AUBURN ST APT 1
NEWBURYPORT MA
01950-3902
US

V. Phone/Fax

Practice location:
  • Phone: 978-927-4110
  • Fax: 978-232-7057
Mailing address:
  • Phone: 781-752-8240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2312470
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: