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Individual

REGGIE DONALD VALDEMAR

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PHMNP

Contact information

Practice address
153 LAKE SHORE RD, RONKONKOMA, NY 11779-3157
(111) 111-1111
Mailing address
7 OAK PARK CT, DEER PARK, NY 11729-5607
(631) 565-3480

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
404034
NY

Other

Enumeration date
03/31/2022
Last updated
12/26/2022
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