MEDICARE: VALJOY BEACH CARE, P.A.

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	363A00000X	Physician Assistant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154733707
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALJOY BEACH CARE, P.A.

Provider Business Mailing Address
First Line	:	13500 NC HIGHWAY 50 STE 104
Second Line	:
City	:	SURF CITY
State	:	NC
Zip	:	28445-7935
Country	:	US
Telephone Number	:	910-803-2025
Fax Number	:	910-803-2027

Provider Business Practice Location Address
First Line	:	13500 NC HIGHWAY 50 STE 104
Second Line	:
City	:	SURF CITY
State	:	NC
Zip	:	28445-7935
Country	:	US
Telephone Number	:	910-803-2025
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SANDY MARGARET MUELLER BRADY
Credential	:	PA-C
Telephone Number	:	910-803-2025

Provider Enumeration Date	:	05/29/2014
Last Update Date	:	03/30/2023

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