Healthcare Provider Details

I. General information

NPI: 1073447348
Provider Name (Legal Business Name): VALERIYA SERGEYEVNA BIRDSEYE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2186 DEEP WOODS WAY
MARIETTA GA
30062-2584
US

IV. Provider business mailing address

2186 DEEP WOODS WAY
MARIETTA GA
30062-2584
US

V. Phone/Fax

Practice location:
  • Phone: 678-294-1248
  • Fax:
Mailing address:
  • Phone: 678-294-1248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN258843
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: