MEDICARE: MICHELLE CUMMINGS

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	363A00000X	Physician Assistant	PA5423	MA

General Provider Information

NPI Number	:	1669855979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE CUMMINGS

Provider Business Mailing Address
First Line	:	1945 COMMONWEALTH AVE
Second Line	:
City	:	BRIGHTON
State	:	MA
Zip	:	02135
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1945 COMMONWEALTH AVE
Second Line	:	#32
City	:	BRIGHTON
State	:	MA
Zip	:	02135-5963
Country	:	US
Telephone Number	:	617-964-0024
Fax Number	:

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

Provider Enumeration Date	:	07/06/2015
Last Update Date	:	02/01/2021

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Directions to “ MICHELLE CUMMINGS ” Practice Location

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