Provider Demographics
NPI:1457825804
Name:VALERIAN, SHARMON MICHELE (MPT)
Entity Type:Individual
Prefix:
First Name:SHARMON
Middle Name:MICHELE
Last Name:VALERIAN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:SHARMON
Other - Middle Name:MICHELE
Other - Last Name:PEDALINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:241 WESTCHESTER DR S
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-4234
Mailing Address - Country:US
Mailing Address - Phone:518-439-0744
Mailing Address - Fax:
Practice Address - Street 1:241 WESTCHESTER DR S
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054
Practice Address - Country:US
Practice Address - Phone:518-439-0744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018868-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist