MEDICARE: KALEY GOVONI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1538706098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KALEY GOVONI

Provider Business Mailing Address
First Line	:	150 CHESTER RD
Second Line	:
City	:	BLANDFORD
State	:	MA
Zip	:	01008-9521
Country	:	US
Telephone Number	:	413-977-2081
Fax Number	:

Provider Business Practice Location Address
First Line	:	84 HIGHLAND AVE STE 311
Second Line	:
City	:	SALEM
State	:	MA
Zip	:	01970-2733
Country	:	US
Telephone Number	:	978-998-0010
Fax Number	:	978-224-2990

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2019
Last Update Date	:	03/06/2025

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Directions to “ KALEY GOVONI ” Practice Location

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