Healthcare Provider Details

I. General information

NPI: 1083665012
Provider Name (Legal Business Name): ANAYDA DEJESUS-CRUZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANAYDA DEJESUS-CRUZ

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 05/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

687 N MAIN ST
ATTLEBORO MA
02703-1518
US

IV. Provider business mailing address

17 STANLEY RD
NORTON MA
02766-2921
US

V. Phone/Fax

Practice location:
  • Phone: 508-222-3200
  • Fax: 508-222-7034
Mailing address:
  • Phone: 508-222-3200
  • Fax: 508-222-7034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number159774
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: