Healthcare Provider Details

I. General information

NPI: 1588646616
Provider Name (Legal Business Name): NATHANIEL L VALIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 MEMORIAL MEDICAL PKWY STE 301
DAYTONA BEACH FL
32117-5157
US

IV. Provider business mailing address

305 MEMORIAL MEDICAL PARKWAY, SUITE 301, SUITE 301 SUITE 301
DAYTONA BEACH FL
32117
US

V. Phone/Fax

Practice location:
  • Phone: 386-677-6672
  • Fax: 386-586-5422
Mailing address:
  • Phone: 386-677-6672
  • Fax: 386-586-5422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMD-25322
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number032799
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: