Provider Demographics
NPI:1083732804
Name:MASOTTI, VALERIE A (MS, PA-C)
Entity Type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:A
Last Name:MASOTTI
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:MRS
Other - First Name:VALERIE
Other - Middle Name:A
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, PA-C
Mailing Address - Street 1:1540 PURDUE DR #101
Mailing Address - Street 2:CAROLINA CHILD NEUROLOGY
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303
Mailing Address - Country:US
Mailing Address - Phone:910-491-2437
Mailing Address - Fax:910-491-2439
Practice Address - Street 1:1540 PURDUE DR #101
Practice Address - Street 2:CAROLINA CHILD NEUROLOGY
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303
Practice Address - Country:US
Practice Address - Phone:910-491-2437
Practice Address - Fax:910-491-2439
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC131882363A00000X
NC0010-00358363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical