Provider Demographics
NPI:1275848749
Name:VALLES, SARY (RN)
Entity Type:Individual
Prefix:MRS
First Name:SARY
Middle Name:
Last Name:VALLES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 S CLINTON AVE
Mailing Address - Street 2:APT 5B
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8654
Mailing Address - Country:US
Mailing Address - Phone:631-697-8802
Mailing Address - Fax:
Practice Address - Street 1:80 S CLINTON AVE
Practice Address - Street 2:APT 5B
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8654
Practice Address - Country:US
Practice Address - Phone:631-697-8802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY567204163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse