Provider Demographics
NPI:1730510884
Name:LLEWELLYN, VICTORIA (PAC)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:LLEWELLYN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:TUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 COLUMBIAN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1601
Mailing Address - Country:US
Mailing Address - Phone:781-624-5000
Mailing Address - Fax:
Practice Address - Street 1:101 COLUMBIAN ST
Practice Address - Street 2:
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1601
Practice Address - Country:US
Practice Address - Phone:781-624-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical