Healthcare Provider Details

I. General information

NPI: 1386221265
Provider Name (Legal Business Name): VALISEMD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5534 BIRCH ST
MILTON FL
32570-2802
US

IV. Provider business mailing address

5534 BIRCH ST
MILTON FL
32570-2802
US

V. Phone/Fax

Practice location:
  • Phone: 850-390-7173
  • Fax: 850-390-7174
Mailing address:
  • Phone: 850-390-7173
  • Fax: 850-390-7174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PATRICK A BLANCHARD
Title or Position: ADMINISTRATOR
Credential:
Phone: 850-390-7173