Healthcare Provider Details

I. General information

NPI: 1912772112
Provider Name (Legal Business Name): MRS. VALERIE ANN MORANDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS VALERIE ANN SHAW

II. Dates (important events)

Enumeration Date: 11/17/2023
Last Update Date: 11/17/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 E BETHPAGE RD STE 5
PLAINVIEW NY
11803-4228
US

IV. Provider business mailing address

12 ADMIRAL RD
MASSAPEQUA NY
11758-7814
US

V. Phone/Fax

Practice location:
  • Phone: 646-666-3088
  • Fax:
Mailing address:
  • Phone: 347-285-0122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: