Healthcare Provider Details

I. General information

NPI: 1962057695
Provider Name (Legal Business Name): AURYANA J MALEK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S MARKET ST
FREDERICK MD
21701-5527
US

IV. Provider business mailing address

1754 BLACKSMITH WAY
FREDERICK MD
21702-1792
US

V. Phone/Fax

Practice location:
  • Phone: 301-600-1393
  • Fax: 301-600-6239
Mailing address:
  • Phone: 571-232-8802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR273686
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: