Provider Demographics
NPI:1508610213
Name:MASSEY, VICTORIA SHACHIA SHONDA
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:SHACHIA SHONDA
Last Name:MASSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-6034
Mailing Address - Country:US
Mailing Address - Phone:781-322-9119
Mailing Address - Fax:
Practice Address - Street 1:919 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-6034
Practice Address - Country:US
Practice Address - Phone:781-322-9119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator