Provider Demographics
NPI:1326398009
Name:SANON, VALENTINE (PA-C)
Entity Type:Individual
Prefix:
First Name:VALENTINE
Middle Name:
Last Name:SANON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5211 NE 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-2705
Mailing Address - Country:US
Mailing Address - Phone:305-751-1293
Mailing Address - Fax:305-758-4855
Practice Address - Street 1:5211 NE 2ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-2705
Practice Address - Country:US
Practice Address - Phone:305-751-1293
Practice Address - Fax:305-758-4855
Is Sole Proprietor?:No
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106719363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL046224100Medicaid
FL046224100Medicaid
FL04267Medicare PIN