Healthcare Provider Details

I. General information

NPI: 1003721150
Provider Name (Legal Business Name): ANDREA CHEDID
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 BROOKLINE AVE UNIT 939
BOSTON MA
02215-3928
US

IV. Provider business mailing address

180 BROOKLINE AVE UNIT 939
BOSTON MA
02215-3928
US

V. Phone/Fax

Practice location:
  • Phone: 617-953-8131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number3019811
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: