Active NPI
Kelli Malkasian, PSYD
- Clinical Psychologist
- Fort Lauderdale, FL
National Provider Identifier
1215471776
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PY 8646
- Practice address
- 2425 E Commercial Blvd
Suite 400a
Fort Lauderdale, FL 33308-4034 - Phone
- (954) 590-0597
- NPI assigned
- Dec 16, 2016
- Last updated
- Dec 16, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PY 8646 | FL | Primary |
Addresses
Primary practice location
2425 E Commercial Blvd
Suite 400a
Fort Lauderdale, FL 33308-4034
Mailing address
1631 NE 63Rd CT
Fort Lauderdale, FL 33334-5125
Phone (561) 789-9746
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY 8646 | FL | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1481846400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1481846400000",
"number": "1215471776",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1631 NE 63RD CT",
"city": "FORT LAUDERDALE",
"state": "FL",
"postal_code": "333345125",
"telephone_number": "561-789-9746"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2425 E COMMERCIAL BLVD",
"address_2": "SUITE 400A",
"city": "FORT LAUDERDALE",
"state": "FL",
"postal_code": "333084034",
"telephone_number": "954-590-0597"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALKASIAN",
"first_name": "KELLI",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-12-16",
"last_updated": "2016-12-16",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "FL",
"license": "PY 8646",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Lauderdale, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.