Provider Demographics
NPI:1992896559
Name:MOSLEY, VALERIE MESHACK (MD)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:MESHACK
Last Name:MOSLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:ST MATTHEWS
Mailing Address - State:SC
Mailing Address - Zip Code:29135-8437
Mailing Address - Country:US
Mailing Address - Phone:803-655-9071
Mailing Address - Fax:803-655-9071
Practice Address - Street 1:3803 BOULDER DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75233-3114
Practice Address - Country:US
Practice Address - Phone:972-502-4020
Practice Address - Fax:214-932-7509
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC285922084P0804X
TXJ78172084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG06860Medicare UPIN