Provider Demographics
NPI:1174048367
Name:VALDEZ, MEDEA YVONNE (PA-C)
Entity type:Individual
Prefix:
First Name:MEDEA
Middle Name:YVONNE
Last Name:VALDEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:536 RICHARD PL
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-1703
Mailing Address - Country:US
Mailing Address - Phone:201-819-1682
Mailing Address - Fax:
Practice Address - Street 1:190 BALDWIN RD STE B
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-2006
Practice Address - Country:US
Practice Address - Phone:973-882-0444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00048900363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant