Provider Demographics
NPI:1083477095
Name:VALENTINO, BROOKE
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:VALENTINO
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 1:4613 CALEDONIA RD
Mailing Address - Street 2:
Mailing Address - City:LEICESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14481-9609
Mailing Address - Country:US
Mailing Address - Phone:585-754-5822
Mailing Address - Fax:
Practice Address - Street 1:130 S PLYMOUTH AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14614-2213
Practice Address - Country:US
Practice Address - Phone:585-753-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311690363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health