Provider Demographics
NPI:1699126003
Name:VALENCIA, MANUELA
Entity type:Individual
Prefix:
First Name:MANUELA
Middle Name:
Last Name:VALENCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:364 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:TUCKAHOE
Mailing Address - State:NY
Mailing Address - Zip Code:10707-1705
Mailing Address - Country:US
Mailing Address - Phone:917-627-0636
Mailing Address - Fax:
Practice Address - Street 1:364 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:TUCKAHOE
Practice Address - State:NY
Practice Address - Zip Code:10707-1705
Practice Address - Country:US
Practice Address - Phone:917-627-0636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide