Basic Information
| Provider Information | |||||||||
| NPI: | 1992006514 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VALENTINO | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13855 EMERSON ST APT 209 | ||||||||
| Address2: | |||||||||
| City: | PALM BEACH GARDENS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334186081 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7073446064 | ||||||||
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| Practice Location | |||||||||
| Address1: | 975 WESTCHESTER AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104593204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183204466 | ||||||||
| FaxNumber: | 7189913829 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2010 | ||||||||
| LastUpdateDate: | 12/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F336168 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 00695941 | 05 | NY | MEDICAID | F336168 | 01 | NY | NYS LICENSE | OTHER |