Provider Demographics
NPI:1740816685
Name:VALENTI, ANJALYSE MARIA (NP-C)
Entity type:Individual
Prefix:MS
First Name:ANJALYSE
Middle Name:MARIA
Last Name:VALENTI
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MS
Other - First Name:ANJALYSE
Other - Middle Name:M
Other - Last Name:VALENTI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP-C
Mailing Address - Street 1:9628 REA RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-6697
Mailing Address - Country:US
Mailing Address - Phone:704-542-5072
Mailing Address - Fax:
Practice Address - Street 1:9628 REA RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-6697
Practice Address - Country:US
Practice Address - Phone:704-905-4221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-22
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024179034363LF0000X
NC5013957363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily