Provider Demographics
NPI:1104391598
Name:HER TRANSFORMATION OBGYN, PLLC
Entity Type:Organization
Organization Name:HER TRANSFORMATION OBGYN, PLLC
Other - Org Name:HER TRANSFORMATION OBGYN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER/MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:VALENTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:EDUSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACOG
Authorized Official - Phone:475-888-0099
Mailing Address - Street 1:2228 BLACK ROCK TPKE STE 211
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-3237
Mailing Address - Country:US
Mailing Address - Phone:475-888-0099
Mailing Address - Fax:475-888-0106
Practice Address - Street 1:2228 BLACK ROCK TPKE STE 211
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-3237
Practice Address - Country:US
Practice Address - Phone:475-888-0099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-11
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty
No207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive SurgeryGroup - Multi-Specialty