Provider Demographics
NPI:1023814142
Name:VELAZQUEZ HERNANDEZ, MAITE MISHEL (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MAITE
Middle Name:MISHEL
Last Name:VELAZQUEZ HERNANDEZ
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 1:435 WESTOVER HILLS BLVD APT 204
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-6339
Mailing Address - Country:US
Mailing Address - Phone:864-376-6043
Mailing Address - Fax:
Practice Address - Street 1:235 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22807-3275
Practice Address - Country:US
Practice Address - Phone:540-568-8860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-20
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-15231363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant