MEDICARE: AMBER VALES

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	174400000X	Specialist		NY

General Provider Information

NPI Number	:	1982301362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER VALES

Provider Business Mailing Address
First Line	:	273 BRIGHTON ST
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10307-1705
Country	:	US
Telephone Number	:	302-242-1566
Fax Number	:

Provider Business Practice Location Address
First Line	:	273 BRIGHTON ST
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10307-1705
Country	:	US
Telephone Number	:	302-242-1566
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2023
Last Update Date	:	02/15/2023

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Directions to “ AMBER VALES ” Practice Location

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