Provider Demographics
NPI:1730284977
Name:VALENA, MARIA ANTONIA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ANTONIA
Last Name:VALENA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH STREET
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6470 N SHADELAND AVE
Practice Address - Street 2:SUITE C
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-4390
Practice Address - Country:US
Practice Address - Phone:317-849-9509
Practice Address - Fax:317-841-1157
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01037902A2084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200040110Medicaid
INE48274Medicare UPIN
IN338240Medicare PIN
INM400027836Medicare PIN
IN200040110Medicaid
IN165490029Medicare PIN