Provider Demographics
NPI:1013770130
Name:VALLADARES, STEPHEN RAY (PMHNP)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:RAY
Last Name:VALLADARES
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 BYKENHULLE RD
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JCT
Mailing Address - State:NY
Mailing Address - Zip Code:12533-6322
Mailing Address - Country:US
Mailing Address - Phone:347-218-3559
Mailing Address - Fax:
Practice Address - Street 1:20 BYKENHULLE RD
Practice Address - Street 2:
Practice Address - City:HOPEWELL JCT
Practice Address - State:NY
Practice Address - Zip Code:12533-6322
Practice Address - Country:US
Practice Address - Phone:347-218-3559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY405609363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health