Provider Demographics
NPI:1194305490
Name:VALENCIA, VANYA ASTRA (PA)
Entity type:Individual
Prefix:
First Name:VANYA
Middle Name:ASTRA
Last Name:VALENCIA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34722 SAN PAULO DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-5733
Mailing Address - Country:US
Mailing Address - Phone:586-489-9756
Mailing Address - Fax:
Practice Address - Street 1:34722 SAN PAULO DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-5733
Practice Address - Country:US
Practice Address - Phone:586-489-9756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-11
Last Update Date:2021-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601010081363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant