Provider Demographics
NPI:1508257478
Name:ANDINO, CHELSEA K (PA)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:K
Last Name:ANDINO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PEARL ST
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-2864
Mailing Address - Country:US
Mailing Address - Phone:508-584-4104
Mailing Address - Fax:
Practice Address - Street 1:1 PEARL ST
Practice Address - Street 2:SUITE 2000
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-2864
Practice Address - Country:US
Practice Address - Phone:508-584-4104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-12
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA000000363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical