Provider Demographics
NPI:1811556095
Name:VASY, VALENTINO (MD)
Entity type:Individual
Prefix:
First Name:VALENTINO
Middle Name:
Last Name:VASY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 COGGINS PL NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-2585
Mailing Address - Country:US
Mailing Address - Phone:770-422-2009
Mailing Address - Fax:
Practice Address - Street 1:1012 COGGINS PL NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-2585
Practice Address - Country:US
Practice Address - Phone:770-422-2009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2024-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1009002084P0800X
OH35.1473432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty