Anastasia Mallore

Primary specialty

Developmental TherapistTaxonomy code 222Q00000X

License

1268331181 Issued in NY

Practice address

6723 Towpath Rd
East Syracuse, NY 13057-9506

Phone

(315) 425-1004

Fax

(315) 422-4855

NPI assigned

Sep 6, 2021

Last updated

Sep 6, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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

• Liberty Resources, Inc.

  • Federally Qualified Health Center (FQHC)
  • Fulton, NY
  • NPI 1700688827
  NPD
• Liberty Resources Psychology, Physical, Occupational and Speech Therap

  • Early Intervention Provider Agency
  • Syracuse, NY
  • NPI 1598065096
  NPD (past)

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

{
    "created_epoch": "1630886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630886400000",
    "number": "1538837356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6723 TOWPATH RD",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "130579506",
            "telephone_number": "315-425-1004",
            "fax_number": "315-422-4855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6723 TOWPATH RD",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "130579506",
            "telephone_number": "315-425-1004",
            "fax_number": "315-422-4855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLORE",
        "first_name": "ANASTASIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-06",
        "last_updated": "2021-09-06",
        "certification_date": "2021-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "222Q00000X",
            "taxonomy_group": "",
            "desc": "Developmental Therapist",
            "state": "NY",
            "license": "1268331181",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NYS DEPT OF EDUCATION",
            "identifier": "3715422",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Magnetic Diagnostic Resources of Central New York, LLP
• M. Christine Mahanna Johnson, MS, CCC/SLP
• Kathleen Susan Mahoney, M.S. ED
• Elizabeth Moore Malcolm, ANP-BC
• Ashley Malcomb
• Emily Malone
• Anthony John Malvasi, D.O.
• Mancera Dental LLC
• Praveen Kumar Mandera Govindaiah, D.M.D
• Paul Manfredo

• Developmental Therapist in East Syracuse, NY
• Providers in East Syracuse, NY by specialty
• Developmental Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2021; 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.