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General NPI Number Information
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NPI Number | 1265803738
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Entity Type | Individual
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Provider Name | ALEXANDRA R. VITALE PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/09/2015
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 15 RIVERSIDE AVE
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City | BRISTOL
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State | CT
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Zip | 06010
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Country | US
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Telephone | 860-585-3333
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Fax |
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Provider Business Mailing Address
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Address Line | 2408 WHITNEY AVE
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City | HAMDEN
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State | CT
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Zip | 06518-3209
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Country | US
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Telephone | 203-626-0160
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Fax | 203-294-6734
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 3455
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 3455
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 3455
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License Number State | CT
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