Provider Demographics
NPI:1811529415
Name:VALASTRO, PETER JOSEPH JR (NP)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:JOSEPH
Last Name:VALASTRO
Suffix:JR
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4705
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-0705
Mailing Address - Country:US
Mailing Address - Phone:518-245-3837
Mailing Address - Fax:518-899-4930
Practice Address - Street 1:37 EVERTS AVE
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-2040
Practice Address - Country:US
Practice Address - Phone:518-793-4700
Practice Address - Fax:518-793-6325
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-11
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY704435163WP0808X
NY403526363LP0808X
NYF403526-01363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06428115Medicaid