Provider Demographics
NPI:1124562608
Name:VALES, MARY CLEONIE
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CLEONIE
Last Name:VALES
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 1:26 SINCLAIR CT
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-4350
Mailing Address - Country:US
Mailing Address - Phone:845-494-8735
Mailing Address - Fax:
Practice Address - Street 1:26 SINCLAIR CT
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-4350
Practice Address - Country:US
Practice Address - Phone:845-494-8735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3258921251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health