Provider Demographics
NPI:1366976581
Name:SEWELL, VICTORIA (PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:
Last Name:SEWELL
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8700 MANCHACA RD
Mailing Address - Street 2:STE 601-602
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-5371
Mailing Address - Country:US
Mailing Address - Phone:512-535-3777
Mailing Address - Fax:512-765-9153
Practice Address - Street 1:37 SUNSET INN RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:NJ
Practice Address - Zip Code:07848
Practice Address - Country:US
Practice Address - Phone:888-494-0032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-13
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00768900363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1366976581Medicaid