MEDICARE: MALYNDA IRENE FOX

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1265053573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALYNDA IRENE FOX

Provider Business Mailing Address
First Line	:	5535 CURRITUCK DR STE 220
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-1155
Country	:	US
Telephone Number	:	910-348-0186
Fax Number	:

Provider Business Practice Location Address
First Line	:	5535 CURRITUCK DR STE 220
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-1155
Country	:	US
Telephone Number	:	910-348-0186
Fax Number	:

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

Provider Enumeration Date	:	04/28/2020
Last Update Date	:	08/08/2024

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Directions to “ MALYNDA IRENE FOX ” Practice Location

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