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General NPI Number Information
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NPI Number | 1811736580
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Entity Type | Organization
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Legal Business Name | AVA MEDICAL PLLC
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Dates
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Enumeration Date | 05/22/2024
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Last Update Date | 05/22/2024
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Provider Practice Location Address
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Address Line | 12 WAYNE MEMORIAL DR
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City | DARTMOUTH
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State | MA
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Zip | 02747-3125
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Country | US
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Telephone | 508-989-8734
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Fax |
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Provider Business Mailing Address
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Address Line | 12 WAYNE MEMORIAL DR
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City | DARTMOUTH
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State | MA
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Zip | 02747-3125
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AMANDA L ASSAF
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Credential | MSN, AGPCNP, NP-C
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Telephone | 508-989-8734
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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