Healthcare Provider Details

I. General information

NPI: 1538385919
Provider Name (Legal Business Name): JACQUELINE C VALDES PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JACQUELINE CHEHEBAR VALDES PHD

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 04/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2214 HOLLYWOOD BLVD
HOLLYWOOD FL
33020-6702
US

IV. Provider business mailing address

406 SW 12TH AVE
DEERFIELD BEACH FL
33442-3108
US

V. Phone/Fax

Practice location:
  • Phone: 954-426-8840
  • Fax: 954-426-6642
Mailing address:
  • Phone: 954-426-1169
  • Fax: 954-725-5814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY4945
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: