Healthcare Provider Details

I. General information

NPI: 1194833186
Provider Name (Legal Business Name): NICOLE ELIZABETH MALANY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 LANCASTER AVE STE 100
BERWYN PA
19312-1734
US

IV. Provider business mailing address

1176 TELEGRAPH RD
WEST CHESTER PA
19380-1615
US

V. Phone/Fax

Practice location:
  • Phone: 610-251-2525
  • Fax:
Mailing address:
  • Phone: 610-431-1167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA003057L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: