Provider Demographics
NPI:1457435299
Name:SHARON H VALENCIA DPM PC
Entity Type:Organization
Organization Name:SHARON H VALENCIA DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JELANE
Authorized Official - Middle Name:K
Authorized Official - Last Name:DOOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-294-8623
Mailing Address - Street 1:30 MATTHEWS ST
Mailing Address - Street 2:SUITE 114
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-1963
Mailing Address - Country:US
Mailing Address - Phone:845-294-8623
Mailing Address - Fax:
Practice Address - Street 1:30 MATTHEWS ST
Practice Address - Street 2:SUITE 114
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-1963
Practice Address - Country:US
Practice Address - Phone:845-294-8623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004732-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01284266Medicaid
NYPBWE11Medicare PIN
NY5959420001Medicare NSC
NYU29580Medicare UPIN