NPIMap

Individual provider Active NPI

Sherilyn Victoria Malloy, DDS

  • Dentist
  • Olympia, WA
National Provider Identifier
1063575033
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
6693 Issued in WA
Practice address
220 Lilly Rd NE
Ste B
Olympia, WA 98506
Phone
(360) 459-9694
Fax
(360) 459-9657
NPI assigned
Dec 19, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 6693 WA Primary
Dentist 122300000X 27724 CA

Addresses

Primary practice location

220 Lilly Rd NE
Ste B
Olympia, WA 98506

Mailing address

220 Lilly Rd NE
Ste B
Olympia, WA 98506
Phone (360) 459-9694

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
27724CAMDDentist
6693WAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Eastside Urgent Care Dentistry Dentist Past Accepting new patients
Lilly Road Family Dentistry Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1063575033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 LILLY RD NE",
            "address_2": "STE B",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "98506",
            "telephone_number": "360-459-9694",
            "fax_number": "360-459-9657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 LILLY RD NE",
            "address_2": "STE B",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "98506",
            "telephone_number": "360-459-9694",
            "fax_number": "360-459-9657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLOY",
        "first_name": "SHERILYN",
        "middle_name": "VICTORIA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "6693",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "27724",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Olympia, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.