MEDICARE: MALLORY KRZYS PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	50.007819RX	OH
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1053035956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALLORY KRZYS PA-C

Provider Business Mailing Address
First Line	:	4009 SHI MAR DR
Second Line	:
City	:	ASHTABULA
State	:	OH
Zip	:	44004-4640
Country	:	US
Telephone Number	:	440-813-1579
Fax Number	:

Provider Business Practice Location Address
First Line	:	1028 S BROADWAY
Second Line	:
City	:	GENEVA
State	:	OH
Zip	:	44041-7124
Country	:	US
Telephone Number	:	647-705-1655
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2022
Last Update Date	:	12/14/2025

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Directions to “ MALLORY KRZYS PA-C” Practice Location

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