MEDICARE: ANITA MALLYA

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	2084A2900X	Neurocritical Care Physician	344574	LA
2	2084A2900X	Neurocritical Care Physician	85276	GA
3	2084N0400X	Neurology Physician	C1-0029133	DE
4	2084A2900X	Neurocritical Care Physician	95679	SC

General Provider Information

NPI Number	:	1508229956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANITA MALLYA

Provider Business Mailing Address
First Line	:	1514 JEFFERSON HWY
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70121-2429
Country	:	US
Telephone Number	:	504-842-4000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1514 JEFFERSON HWY
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70121-2429
Country	:	US
Telephone Number	:	504-842-3980
Fax Number	:

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

Provider Enumeration Date	:	04/02/2016
Last Update Date	:	02/11/2026

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Directions to “ ANITA MALLYA ” Practice Location

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