Healthcare Provider Details

I. General information

NPI: 1295599462
Provider Name (Legal Business Name): VICTORIA WILSON ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2024
Last Update Date: 01/12/2026
Certification Date: 01/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 MAIN ST FL 2
WEST SPRINGFIELD MA
01089-3903
US

IV. Provider business mailing address

184 MAIN ST FL 2
WEST SPRINGFIELD MA
01089-3903
US

V. Phone/Fax

Practice location:
  • Phone: 914-577-1352
  • Fax:
Mailing address:
  • Phone: 914-577-1352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. AWAIS CHUGHTAI
Title or Position: CEO
Credential:
Phone: 914-577-1352