Provider Demographics
NPI:1639386014
Name:VALDER, ODETTE CIANCHINI (MD)
Entity Type:Individual
Prefix:DR
First Name:ODETTE
Middle Name:CIANCHINI
Last Name:VALDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:734 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-3106
Mailing Address - Country:US
Mailing Address - Phone:704-375-9034
Mailing Address - Fax:704-365-4412
Practice Address - Street 1:413 S SHARON AMITY RD
Practice Address - Street 2:SUITE B
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2865
Practice Address - Country:US
Practice Address - Phone:704-365-4545
Practice Address - Fax:704-365-4412
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC95002562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCF97499Medicare UPIN
NC2281120Medicare ID - Type Unspecified