Healthcare Provider Details

I. General information

NPI: 1073681904
Provider Name (Legal Business Name): PHYLLIS A MASSAC RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 B PRINDSENS GADE
ST.THOMAS VI
00801-1980
US

IV. Provider business mailing address

PO BOX 8980
ST THOMAS VI
00801-1980
US

V. Phone/Fax

Practice location:
  • Phone: 340-774-9177
  • Fax:
Mailing address:
  • Phone: 340-776-5017
  • Fax: 340-693-2697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number1464
License Number StateVI
# 2
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number1464
License Number StateVI
# 3
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number1464
License Number StateVI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: