Healthcare Provider Details

I. General information

NPI: 1508478793
Provider Name (Legal Business Name): LINDSAY ANNE TETREAULT MB, BCH, BAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2696
US

IV. Provider business mailing address

1 LONGFELLOW PL APT 3311
BOSTON MA
02114-2431
US

V. Phone/Fax

Practice location:
  • Phone: 775-203-8307
  • Fax:
Mailing address:
  • Phone: 775-203-8307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number1018478
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number1018478
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: