Provider Demographics
NPI:1497802425
Name:MASTO, PAULA VIDA (APRN)
Entity Type:Individual
Prefix:MISS
First Name:PAULA
Middle Name:VIDA
Last Name:MASTO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:PAULA
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:13 PECK ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-2308
Mailing Address - Country:US
Mailing Address - Phone:203-239-4627
Mailing Address - Fax:203-234-8533
Practice Address - Street 1:13 PECK ST
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-2308
Practice Address - Country:US
Practice Address - Phone:203-239-4627
Practice Address - Fax:203-234-8533
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002893363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004232302Medicaid