MEDICARE: LAKITRIA SHALANE MALONE

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	332B00000X	Durable Medical Equipment & Medical Supplies		TX

General Provider Information

NPI Number	:	1154277861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAKITRIA SHALANE MALONE

Provider Business Mailing Address
First Line	:	2412 BROOKSIDE DR
Second Line	:
City	:	ROYSE CITY
State	:	TX
Zip	:	75189-3139
Country	:	US
Telephone Number	:	214-690-6694
Fax Number	:

Provider Business Practice Location Address
First Line	:	2412 BROOKSIDE DR, ROYSE CITY TEXAS 75189
Second Line	:
City	:	ROYSE CITY
State	:	TX
Zip	:	75189
Country	:	US
Telephone Number	:	214-690-6694
Fax Number	:

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

Provider Enumeration Date	:	03/05/2026
Last Update Date	:	03/05/2026

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Directions to “ LAKITRIA SHALANE MALONE ” Practice Location

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