Healthcare Provider Details

I. General information

NPI: 1770212003
Provider Name (Legal Business Name): VICTORIA CANCEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

379 W BROADWAY OFC 549
NEW YORK NY
10012-5121
US

IV. Provider business mailing address

313 PARK AVE APT 453
DETROIT MI
48226-1777
US

V. Phone/Fax

Practice location:
  • Phone: 191-738-2435
  • Fax:
Mailing address:
  • Phone: 267-574-1571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number000794
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1601001230
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD100164
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD004401
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number145.0133389
License Number StateVT
# 6
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2201002005
License Number StateVA
# 7
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number919-684-3859
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: