# HER TRANSFORMATION OBGYN, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** HER TRANSFORMATION OBGYN
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104391598
- **Authorized official:** VALENTINE EDUSA MD, FACOG (FOUNDER/MANAGING MEMBER)
- **Authorized official phone:** (475) 888-0099

## Contact information

- **Practice address:** 2228 BLACK ROCK TPKE STE 211, FAIRFIELD, CT 06825-3237
- **Practice address phone:** (475) 888-0099
- **Mailing address:** 2228 BLACK ROCK TPKE STE 211, FAIRFIELD, CT 06825-3237
- **Mailing address phone:** (475) 888-0099
- **Mailing address fax:** (475) 888-0106

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/11/2018
- **Last updated:** 05/10/2019