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Individual

STEPHANIE MARIE MASSA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.A.

Contact information

Practice address
874 PURCHASE ST, NEW BEDFORD, MA 02740-6232
(508) 992-6553
Mailing address
874 PURCHASE ST, NEW BEDFORD, MA 02740-6232
(508) 992-6553

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9107140
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
PA00882
STATE LICENSE
RI
01
PA5780
PA STATE LICENSE
MA
01
PA9107140
PHYSICIAN ASSISTANT LICENSE
FL
Enumeration date
04/14/2013
Last updated
10/19/2016
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