Basic Information
| Provider Information | |||||||||
| NPI: | 1114314119 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MALATY | ||||||||
| FirstName: | SHERY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1263 | ||||||||
| Address2: | |||||||||
| City: | CEDAR PARK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786301263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3619026570 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2606 HOSPITAL BLVD 5 WEST, | ||||||||
| Address2: | |||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3619026570 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2015 | ||||||||
| LastUpdateDate: | 08/05/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 01079654A | IN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | R8415 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
ID Information
| ID | Type | State | Issuer | Description | 01079654A | 01 | IN | STATE LICENSE | OTHER |