Provider Demographics
NPI:1407683998
Name:VASU, NATALIE THERESA (PA-C)
Entity type:Individual
Prefix:MS
First Name:NATALIE
Middle Name:THERESA
Last Name:VASU
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5102 WILLIAMSBURG DR
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-3237
Mailing Address - Country:US
Mailing Address - Phone:440-787-7220
Mailing Address - Fax:
Practice Address - Street 1:3555 10TH CT STE 200A
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5013
Practice Address - Country:US
Practice Address - Phone:772-563-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2025-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9120849363A00000X
OH50.009295RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant