Basic Information
Provider Information
NPI: 1093455941
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VALLERY
FirstName: ANTHONY
MiddleName: R
NamePrefix:  
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8881 BETONY CT
Address2:  
City: REYNOLDSBURG
State: OH
PostalCode: 430686770
CountryCode: US
TelephoneNumber: 7405382420
FaxNumber:  
Practice Location
Address1: 455 SHAWNEE LN
Address2:  
City: CHILLICOTHE
State: OH
PostalCode: 456014145
CountryCode: US
TelephoneNumber: 7407794888
FaxNumber: 7407794898
Other Information
ProviderEnumerationDate: 03/30/2022
LastUpdateDate: 03/30/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/30/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084P0800X58.032769OHY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry

No ID Information.


Home