Provider Demographics
NPI:1477981108
Name:ADAMS, VICTORIA MERAUTI (NP)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:MERAUTI
Last Name:ADAMS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:MERAUTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:594 DEAN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-3009
Mailing Address - Country:US
Mailing Address - Phone:800-475-6168
Mailing Address - Fax:
Practice Address - Street 1:34 34TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11232-2014
Practice Address - Country:US
Practice Address - Phone:929-379-3913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-15
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY338350363LF0000X, 363LF0000X
SC20930363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP4798Medicaid