Provider Demographics
NPI:1790563757
Name:AFONSO, VICTORIA E (PA-C)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:E
Last Name:AFONSO
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 1:309 PURGATORY RD
Mailing Address - Street 2:
Mailing Address - City:WHITINSVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:01588-1631
Mailing Address - Country:US
Mailing Address - Phone:508-266-5010
Mailing Address - Fax:
Practice Address - Street 1:309 PURGATORY RD
Practice Address - Street 2:
Practice Address - City:WHITINSVILLE
Practice Address - State:MA
Practice Address - Zip Code:01588-1631
Practice Address - Country:US
Practice Address - Phone:508-266-5010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-20
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA100107363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant