Provider Demographics
NPI:1205328564
Name:VALERIS, EMMANUELLA (LVN)
Entity type:Individual
Prefix:
First Name:EMMANUELLA
Middle Name:
Last Name:VALERIS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 W 14TH ST
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-4019
Mailing Address - Country:US
Mailing Address - Phone:631-504-8554
Mailing Address - Fax:
Practice Address - Street 1:11 W 14TH ST
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-4019
Practice Address - Country:US
Practice Address - Phone:631-504-8554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-03
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX348555164X00000X
NY326951164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse