Basic Information
| Provider Information | |||||||||
| NPI: | 1457441834 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TUTTLE-MALONE | ||||||||
| FirstName: | SHIRLEY | ||||||||
| MiddleName: | |||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 180 | ||||||||
| Address2: | |||||||||
| City: | BEAVER FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 133050180 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153466824 | ||||||||
| FaxNumber: | 3153466868 | ||||||||
| Practice Location | |||||||||
| Address1: | 9559 MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | BEAVER FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153466824 | ||||||||
| FaxNumber: | 3153466868 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2006 | ||||||||
| LastUpdateDate: | 02/10/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 194581 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01559411 | 05 | NY | MEDICAID |