Healthcare Provider Details

I. General information

NPI: 1275438475
Provider Name (Legal Business Name): SHYANNE MALAEB
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 JOLIET AVE
LUBBOCK TX
79415-1149
US

IV. Provider business mailing address

2908 VALENCIA AVE
LUBBOCK TX
79407-5001
US

V. Phone/Fax

Practice location:
  • Phone: 806-761-0545
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1251396
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: