Provider Demographics
NPI:1154733707
Name:VALJOY BEACH CARE, P.A.
Entity type:Organization
Organization Name:VALJOY BEACH CARE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:MUELLER BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:910-803-2025
Mailing Address - Street 1:13500 NC HIGHWAY 50 STE 104
Mailing Address - Street 2:
Mailing Address - City:SURF CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28445-7935
Mailing Address - Country:US
Mailing Address - Phone:910-803-2025
Mailing Address - Fax:910-803-2027
Practice Address - Street 1:13500 NC HIGHWAY 50 STE 104
Practice Address - Street 2:
Practice Address - City:SURF CITY
Practice Address - State:NC
Practice Address - Zip Code:28445-7935
Practice Address - Country:US
Practice Address - Phone:910-803-2025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-29
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1154733707Medicaid