Healthcare Provider Details

I. General information

NPI: 1659507705
Provider Name (Legal Business Name): VERONICA JOAN VAIDA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2009
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SOUTH ST SUITE G05
SOUTHBRIDGE MA
01550-4051
US

IV. Provider business mailing address

100 SOUTH ST SUITE G05
SOUTHBRIDGE MA
01550-4051
US

V. Phone/Fax

Practice location:
  • Phone: 508-765-5981
  • Fax: 508-764-4637
Mailing address:
  • Phone: 508-765-5981
  • Fax: 508-764-4637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberRN208888
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: