Healthcare Provider Details

I. General information

NPI: 1497001556
Provider Name (Legal Business Name): FARAH FALDONIE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2012
Last Update Date: 08/13/2021
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 WASHINGTON ST
BOSTON MA
02111-1416
US

IV. Provider business mailing address

1575 BLUE HILL AVE
MATTAPAN MA
02126-2122
US

V. Phone/Fax

Practice location:
  • Phone: 617-635-8497
  • Fax:
Mailing address:
  • Phone: 617-296-0061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN2269209
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2269209
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: