Provider Demographics
NPI:1689034191
Name:CARDENAS, VALERIA MELISSA
Entity type:Individual
Prefix:
First Name:VALERIA
Middle Name:MELISSA
Last Name:CARDENAS
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 1:4108 GEORGE RD UNIT 2421
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-7574
Mailing Address - Country:US
Mailing Address - Phone:786-277-4383
Mailing Address - Fax:
Practice Address - Street 1:1211 N WEST SHORE BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-4600
Practice Address - Country:US
Practice Address - Phone:813-515-9008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-25
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
FLPT211389208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst