Healthcare Provider Details

I. General information

NPI: 1649893165
Provider Name (Legal Business Name): SAMUEL WUEST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2020
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 RAYMOND ST APT A
BOSTON MA
02134-1117
US

IV. Provider business mailing address

3 RAYMOND ST APT A
BOSTON MA
02134-1117
US

V. Phone/Fax

Practice location:
  • Phone: 508-904-2566
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: