Provider Demographics
NPI:1891406500
Name:VALDES, TAILI
Entity Type:Individual
Prefix:
First Name:TAILI
Middle Name:
Last Name:VALDES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17842 SW 107TH AVE APT 25
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-5115
Mailing Address - Country:US
Mailing Address - Phone:786-792-4124
Mailing Address - Fax:
Practice Address - Street 1:17842 SW 107TH AVE APT 25
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-5115
Practice Address - Country:US
Practice Address - Phone:786-792-4124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist