Provider Demographics
NPI:1336472125
Name:VALENTI, VANESSA (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:
Last Name:VALENTI
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 BELLE MEAD ROAD
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3522
Mailing Address - Country:US
Mailing Address - Phone:631-689-1400
Mailing Address - Fax:
Practice Address - Street 1:210 BELLE MEAD RD
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733
Practice Address - Country:US
Practice Address - Phone:631-689-1400
Practice Address - Fax:631-689-1595
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013020363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical