Provider Demographics
NPI:1750580437
Name:O'NEAL, ALICIA DENISE (PA-C)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:DENISE
Last Name:O'NEAL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:D
Other - Last Name:O'NEAL VAUGHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:1300 SENTARA PARK FL 3
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-5884
Mailing Address - Country:US
Mailing Address - Phone:757-383-2217
Mailing Address - Fax:757-222-3106
Practice Address - Street 1:1300 SENTARA PARK FL 3
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-5884
Practice Address - Country:US
Practice Address - Phone:757-252-3050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002550363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV4762A - C03895Medicare PIN