Provider Demographics
NPI:1427426006
Name:VALLONE, THERESA MAE (APN)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:MAE
Last Name:VALLONE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2224 OAK ST
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-1312
Mailing Address - Country:US
Mailing Address - Phone:201-575-2658
Mailing Address - Fax:703-373-0728
Practice Address - Street 1:2224 OAK ST
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-1312
Practice Address - Country:US
Practice Address - Phone:201-575-2658
Practice Address - Fax:703-373-0728
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-13
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL04152025363LF0000X
NH11398723363LF0000X
NJ26NJ00580500363LF0000X
VA0024192811363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NJ00580500OtherLICENSE NUMBER