Provider Demographics
NPI:1598377699
Name:BOADU, VICTOR O (DNP, CNP, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:O
Last Name:BOADU
Suffix:
Gender:M
Credentials:DNP, CNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 BOSTON TPKE STE 201
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-3414
Mailing Address - Country:US
Mailing Address - Phone:508-365-5228
Mailing Address - Fax:508-213-3995
Practice Address - Street 1:415 BOSTON TPKE STE 201
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-3414
Practice Address - Country:US
Practice Address - Phone:508-365-5228
Practice Address - Fax:508-213-3995
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2283917363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health