Healthcare Provider Details

I. General information

NPI: 1801853056
Provider Name (Legal Business Name): MARIA TERESA VALDES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 01/22/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

774 SR 13 NORTH SUITE 6
ST JOHNS FL
32259-3815
US

IV. Provider business mailing address

774 SR 13 NORTH SUITE 6
ST JOHNS FL
32259-3815
US

V. Phone/Fax

Practice location:
  • Phone: 904-786-9600
  • Fax: 904-786-6036
Mailing address:
  • Phone: 904-786-9600
  • Fax: 904-786-6036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME53283
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: