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General NPI Number Information
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NPI Number | 1770724148
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Entity Type | Individual
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Provider Name | SHAUNN DOMINIQUE MALAKA DPM
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Gender | Female
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Dates
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Enumeration Date | 03/16/2009
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Last Update Date | 01/11/2018
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Provider Practice Location Address
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Address Line | 14904 JEFFERSON DAVIS HWY STE 105
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City | WOODBRIDGE
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State | VA
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Zip | 22191-3908
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Country | US
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Telephone | 703-490-8171
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Fax | 703-490-8172
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Provider Business Mailing Address
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Address Line | 14904 JEFFERSON DAVIS HWY STE 105
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City | WOODBRIDGE
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State | VA
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Zip | 22191-3908
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Country | US
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Telephone | 703-490-8171
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Fax | 703-490-8172
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 684
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 01481
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO1000072
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License Number State | DC
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Taxonomy #4
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 0103301025
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License Number State | VA
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