Provider Demographics
NPI:1659507705
Name:VAIDA, VERONICA JOAN (NP)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:JOAN
Last Name:VAIDA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SOUTH ST
Mailing Address - Street 2:SUITE G05
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-4051
Mailing Address - Country:US
Mailing Address - Phone:508-765-5981
Mailing Address - Fax:508-764-4637
Practice Address - Street 1:100 SOUTH ST
Practice Address - Street 2:SUITE G05
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550-4051
Practice Address - Country:US
Practice Address - Phone:508-765-5981
Practice Address - Fax:508-764-4637
Is Sole Proprietor?:No
Enumeration Date:2009-06-03
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN208888363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP293201Medicare PIN