Provider Demographics
NPI:1093244204
Name:FLAVIN-LEE, PAMELA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:
Last Name:FLAVIN-LEE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 OXFORD CIR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-3226
Mailing Address - Country:US
Mailing Address - Phone:757-869-9649
Mailing Address - Fax:
Practice Address - Street 1:5239 MONTICELLO AVE STE C
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-8242
Practice Address - Country:US
Practice Address - Phone:757-279-2999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-09
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110005760363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant