Provider Demographics
NPI:1528776465
Name:MASULLO, ALEXANDRA (PA-C)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:MASULLO
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 1:7 CHURCH CT UNIT 2
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-3307
Mailing Address - Country:US
Mailing Address - Phone:203-942-4817
Mailing Address - Fax:
Practice Address - Street 1:7 CHURCH CT UNIT 2
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:MA
Practice Address - Zip Code:02129-3307
Practice Address - Country:US
Practice Address - Phone:203-942-4817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant