MEDICARE: VALIANTMD PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1114692985
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALIANTMD PLLC

Provider Business Mailing Address
First Line	:	4806 RIVERSTONE BLVD
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-4092
Country	:	US
Telephone Number	:	562-999-6519
Fax Number	:

Provider Business Practice Location Address
First Line	:	4806 RIVERSTONE BLVD
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-4092
Country	:	US
Telephone Number	:	562-999-6519
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MS. SUPRIYA KIDAMBI
Credential	:
Telephone Number	:	562-999-6519

Provider Enumeration Date	:	08/12/2021
Last Update Date	:	08/12/2021

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Directions to “VALIANTMD PLLC ” Practice Location

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