Provider Demographics
NPI:1669626156
Name:MALLORY, DANA ELIZABETH (MS, CCC-SLP, RN, BSN)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:ELIZABETH
Last Name:MALLORY
Suffix:
Gender:F
Credentials:MS, CCC-SLP, RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7120 BROOKVIEW LN
Mailing Address - Street 2:
Mailing Address - City:SHERRILLS FORD
Mailing Address - State:NC
Mailing Address - Zip Code:28673-9514
Mailing Address - Country:US
Mailing Address - Phone:845-514-7793
Mailing Address - Fax:
Practice Address - Street 1:7120 BROOKVIEW LN
Practice Address - Street 2:
Practice Address - City:SHERRILLS FORD
Practice Address - State:NC
Practice Address - Zip Code:28673-9514
Practice Address - Country:US
Practice Address - Phone:845-514-7793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2025-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY607662-1163W00000X
NC376253163W00000X
NY013221-1235Z00000X
NC30003595235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No163W00000XNursing Service ProvidersRegistered Nurse