Provider Demographics
NPI:1386342798
Name:VAICIKAUSKAS, EDVINAS (PA-C)
Entity type:Individual
Prefix:
First Name:EDVINAS
Middle Name:
Last Name:VAICIKAUSKAS
Suffix:
Gender:
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 1:701 S NEW BALLAS RD STE 330
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8725
Mailing Address - Country:US
Mailing Address - Phone:314-251-8850
Mailing Address - Fax:
Practice Address - Street 1:701 S NEW BALLAS RD STE 330
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8725
Practice Address - Country:US
Practice Address - Phone:314-251-8850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5421363A00000X
MO2024009541363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant