Provider Demographics
NPI:1336572387
Name:SOM, VALENTINA (PMHNP-BC,MD)
Entity Type:Individual
Prefix:
First Name:VALENTINA
Middle Name:
Last Name:SOM
Suffix:
Gender:F
Credentials:PMHNP-BC,MD
Other - Prefix:
Other - First Name:VALENTINA
Other - Middle Name:
Other - Last Name:CAVDARSKA-SHAMPTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:425 JACK MARTIN BLVD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-7732
Mailing Address - Country:US
Mailing Address - Phone:732-836-4084
Mailing Address - Fax:732-836-4005
Practice Address - Street 1:425 JACK MARTIN BLVD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724
Practice Address - Country:US
Practice Address - Phone:732-836-4084
Practice Address - Fax:732-836-4005
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00453700363LP0808X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health