Provider Demographics
NPI:1700561123
Name:MASELLI, VICTORIA MARIE (CO)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:MARIE
Last Name:MASELLI
Suffix:
Gender:F
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2680 HENDERSON DR STE 3
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-5297
Mailing Address - Country:US
Mailing Address - Phone:910-219-1455
Mailing Address - Fax:910-219-1456
Practice Address - Street 1:2680 HENDERSON DR STE 3
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-5297
Practice Address - Country:US
Practice Address - Phone:910-219-1455
Practice Address - Fax:910-219-1456
Is Sole Proprietor?:No
Enumeration Date:2023-06-21
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist