Provider Demographics
NPI:1053601484
Name:VALDES, KWANA
Entity type:Individual
Prefix:MS
First Name:KWANA
Middle Name:
Last Name:VALDES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 MADISON AVE
Mailing Address - Street 2:#12C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-2804
Mailing Address - Country:US
Mailing Address - Phone:646-548-8720
Mailing Address - Fax:
Practice Address - Street 1:781 E 142ND ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454-1723
Practice Address - Country:US
Practice Address - Phone:718-993-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242115164W00000X
NY737619163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse