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NPI Code Detail

MEDICARE: DR. MALINDA JAY LYON DO

MEDICARE:  DR. MALINDA JAY LYON  DO
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
1208600000XSurgery Physician0102206155VA
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1255728374
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MALINDA JAY LYON DO
Provider Business Mailing Address
First Line : 100 BREWSTER BLVD
Second Line :
City : CAMP LEJEUNE
State : NC
Zip : 28547-2575
Country : US
Telephone Number : 303-335-8954
Fax Number :
Provider Business Practice Location Address
First Line : 8150 SHORE DRIVE
Second Line : #522
City : NORFOLK
State : VA
Zip : 23518
Country : US
Telephone Number : 303-335-8954
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2015
Last Update Date : 12/02/2025

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Directions to “ DR. MALINDA JAY LYON DO” Practice Location

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