Healthcare Provider Details

I. General information

NPI: 1912310723
Provider Name (Legal Business Name): SARA L VALENTE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 GLEN COVE DR
ROCKPORT ME
04856-4232
US

IV. Provider business mailing address

3 GLEN COVE DR
ROCKPORT ME
04856-4232
US

V. Phone/Fax

Practice location:
  • Phone: 201-301-5400
  • Fax:
Mailing address:
  • Phone: 201-301-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number0101265940
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD24396
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: