Healthcare Provider Details

I. General information

NPI: 1588070304
Provider Name (Legal Business Name): PAMELA VALENTINO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 01/07/2022
Certification Date: 01/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CEDAR ST LMP 4093A
NEW HAVEN CT
06510-3206
US

IV. Provider business mailing address

333 CEDAR ST LMP 4093A, PO BOX 208064
NEW HAVEN CT
06510-3206
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-4649
  • Fax:
Mailing address:
  • Phone: 203-785-4649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number258247
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2080T0004X
TaxonomyPediatric Transplant Hepatology Physician
License Number54054
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code2080T0004X
TaxonomyPediatric Transplant Hepatology Physician
License NumberMD.61237984
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number258247
License Number StateMA
# 5
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberMD.61237984
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: