Provider Demographics
NPI:1043656325
Name:CHANG-MISHRA, VICTORIA (PA)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:CHANG-MISHRA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:801 E PLANO PKWY
Mailing Address - Street 2:SUITE 140
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-6746
Mailing Address - Country:US
Mailing Address - Phone:469-800-6230
Mailing Address - Fax:469-800-6235
Practice Address - Street 1:801 E PLANO PKWY
Practice Address - Street 2:SUITE 140
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-6746
Practice Address - Country:US
Practice Address - Phone:469-800-6230
Practice Address - Fax:469-800-6235
Is Sole Proprietor?:No
Enumeration Date:2013-05-14
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA08044363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX395189YKP5Medicare PIN