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General NPI Number Information
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NPI Number | 1710684592
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Entity Type | Individual
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Provider Name | ALESSIA PRIMAVERA SEVERINO PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/13/2023
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 2301 E EVESHAM RD STE 110A
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City | VOORHEES
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State | NJ
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Zip | 08043-4501
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Country | US
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Telephone | 856-325-4200
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Fax |
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Provider Business Mailing Address
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Address Line | 301 LIPPINCOTT DR STE 410
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City | MARLTON
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State | NJ
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Zip | 08053-4197
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Country | US
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Telephone | 856-355-0340
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Fax |
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 9118030
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 25MP00885100
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License Number State | NJ
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