Provider Demographics
NPI:1255130431
Name:VALERIO, BRANDON
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:VALERIO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 SHADOW PINE DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-8317
Mailing Address - Country:US
Mailing Address - Phone:217-899-0739
Mailing Address - Fax:
Practice Address - Street 1:860 SHADOW PINE DR
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-8317
Practice Address - Country:US
Practice Address - Phone:217-899-0739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017024042163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse