Provider Demographics
NPI:1477910537
Name:KUMARELAS, VASSO ANEST (PA-C)
Entity Type:Individual
Prefix:
First Name:VASSO
Middle Name:ANEST
Last Name:KUMARELAS
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1720 W HORIZON RIDGE PKWY STE 140
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-4896
Mailing Address - Country:US
Mailing Address - Phone:702-566-5445
Mailing Address - Fax:702-566-5035
Practice Address - Street 1:1285 BEACON ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5237
Practice Address - Country:US
Practice Address - Phone:617-751-6205
Practice Address - Fax:617-487-8663
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVPA1688363AM0700X
MAMA6390363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical