Healthcare Provider Details

I. General information

NPI: 1053569558
Provider Name (Legal Business Name): VIOLA VALLONE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 09/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4355 PEET ST
MIDDLEPORT NY
14105-9607
US

IV. Provider business mailing address

4355 PEET ST
MIDDLEPORT NY
14105-9607
US

V. Phone/Fax

Practice location:
  • Phone: 716-735-3785
  • Fax:
Mailing address:
  • Phone: 716-735-3785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number358867-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: