Provider Demographics
NPI:1063130722
Name:RADEL, VICTORIA CELESTE (PA-C)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:CELESTE
Last Name:RADEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9180 PLEASANTVALE CT
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-7334
Mailing Address - Country:US
Mailing Address - Phone:440-897-9221
Mailing Address - Fax:
Practice Address - Street 1:8655 MARKET ST STE 200
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4112
Practice Address - Country:US
Practice Address - Phone:440-255-7938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH50.007775RXOtherELICENSE OHIO PROFESSIONAL LICENSE