Organization
SUFFOLK PSYCHIATRIC GROUP
Active
Other names
SUFFOLK PSYCHIATRIC GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HAYDEH ESMAILI (OWNER)
(757) 539-1503
Entity
Organization
Contact information
Practice address
2470 PRUDEN BLVD, SUFFOLK, VA 23434-4206
(757) 539-1503
(757) 539-0107
Mailing address
2470 PRUDEN BLVD, SUFFOLK, VA 23434-4206
(757) 539-1503
(757) 539-0107
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0101039180
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010413761
—
VA
Enumeration date
10/20/2006
Last updated
04/28/2008
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