Provider Demographics
NPI:1649053695
Name:DEMICHEL, VICTORIA ROSE (PA-C)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ROSE
Last Name:DEMICHEL
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 1:7238 113TH ST APT 4G
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4640
Mailing Address - Country:US
Mailing Address - Phone:815-630-6156
Mailing Address - Fax:
Practice Address - Street 1:611 NORTHERN BLVD STE 200
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5208
Practice Address - Country:US
Practice Address - Phone:516-773-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant