Provider Demographics
NPI:1619473709
Name:DELLOSTRITTO, OLIVIA CAROLINE (PA-C)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:CAROLINE
Last Name:DELLOSTRITTO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 KENILWORTH RD
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01602-1840
Mailing Address - Country:US
Mailing Address - Phone:774-262-4616
Mailing Address - Fax:
Practice Address - Street 1:836 FARMINGTON AVE STE 207
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1551
Practice Address - Country:US
Practice Address - Phone:860-232-9911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical