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General NPI Number Information
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NPI Number | 1285511683
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Entity Type | Individual
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Provider Name | IMANI SADE MALLARD RN, IBCLC
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Gender | Female
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Dates
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Enumeration Date | 08/18/2025
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Last Update Date | 08/18/2025
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Provider Practice Location Address
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Address Line | 1020 19TH ST NW STE 150
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City | WASHINGTON
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State | DC
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Zip | 20036-6103
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Country | US
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Telephone | 202-293-5182
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Fax |
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Provider Business Mailing Address
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Address Line | 10945 PRICE MANOR WAY
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City | LAUREL
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State | MD
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Zip | 20723-6036
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WN0002X
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Taxonomy Name | Neonatal Intensive Care Registered Nurse
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License Number | R254502
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 163WN0003X
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Taxonomy Name | Low-Risk Neonatal Registered Nurse
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License Number | RN500016940
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 163WL0100X
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Taxonomy Name | Lactation Consultant (Registered Nurse)
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License Number | L-319151
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License Number State | MD
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