Provider Demographics
NPI:1275661613
Name:PANDAK, VALERI' (EI)
Entity Type:Individual
Prefix:
First Name:VALERI'
Middle Name:
Last Name:PANDAK
Suffix:
Gender:F
Credentials:EI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3541 N.W. 24TH BLVD
Mailing Address - Street 2:#107
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605
Mailing Address - Country:US
Mailing Address - Phone:352-359-8787
Mailing Address - Fax:
Practice Address - Street 1:111 NATURE WALK PARKWAY SUITE 101
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092
Practice Address - Country:US
Practice Address - Phone:904-230-7761
Practice Address - Fax:904-230-7763
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator