Provider Demographics
NPI: | 1811045230 |
---|---|
Name: | WESTHEAD, VALERIE ANN (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | VALERIE |
Middle Name: | ANN |
Last Name: | WESTHEAD |
Suffix: | |
Gender: | F |
Credentials: | MD |
Other - Prefix: | MRS |
Other - First Name: | VALERIE |
Other - Middle Name: | WEASTHEAD |
Other - Last Name: | TONNER |
Other - Suffix: | |
Other - Last Name Type: | Other Name |
Other - Credentials: | MD |
Mailing Address - Street 1: | 216 HEATHERWOOD COURT |
Mailing Address - Street 2: | |
Mailing Address - City: | WINTER SPRINGS |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 32708 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 407-359-1740 |
Mailing Address - Fax: | 407-365-6044 |
Practice Address - Street 1: | 300 BAY AVENUE |
Practice Address - Street 2: | |
Practice Address - City: | SANFORD |
Practice Address - State: | FL |
Practice Address - Zip Code: | 32771 |
Practice Address - Country: | US |
Practice Address - Phone: | 407-321-4357 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-01-08 |
Last Update Date: | 2007-07-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | ME77343 | 2084P0800X |
WI | 27112 | 2084P0800X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
WI | 31433800 | Medicaid | |
FL | E2397Z | Medicare ID - Type Unspecified | |
WI | 02341 | Medicare ID - Type Unspecified | |
B57576 | Medicare UPIN |