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General NPI Number Information
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NPI Number | 1962865097
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Entity Type | Individual
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Provider Name | FARYAL J MALLICK MD
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Gender | Female
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Dates
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Enumeration Date | 04/05/2016
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 14003 N DALE MABRY HWY STE C
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City | TAMPA
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State | FL
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Zip | 33618-2459
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Country | US
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Telephone | 813-461-7797
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Fax |
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Provider Business Mailing Address
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Address Line | 10006 CROSS CREEK BLVD STE 124
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City | TAMPA
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State | FL
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Zip | 33647-2595
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Country | US
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Telephone | 813-461-7707
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | TP944
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 51944
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | ME140149
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License Number State | FL
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