Provider Demographics
NPI:1780187773
Name:DELADURANTAYE, VALERIE RAE (BS QMHP QIDP)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:RAE
Last Name:DELADURANTAYE
Suffix:
Gender:F
Credentials:BS QMHP QIDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 CASS AVE
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-8736
Mailing Address - Country:US
Mailing Address - Phone:989-895-2273
Mailing Address - Fax:
Practice Address - Street 1:1961 PARISH RD
Practice Address - Street 2:
Practice Address - City:KAWKAWLIN
Practice Address - State:MI
Practice Address - Zip Code:48631-9459
Practice Address - Country:US
Practice Address - Phone:989-895-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist