Healthcare Provider Details

I. General information

NPI: 1649103011
Provider Name (Legal Business Name): SHALAYNES ALVAREZ-BUENO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 VICTORY RD
BOSTON MA
02122-3518
US

IV. Provider business mailing address

105 VICTORY RD
BOSTON MA
02122-3518
US

V. Phone/Fax

Practice location:
  • Phone: 617-371-3010
  • Fax: 617-371-3044
Mailing address:
  • Phone: 617-371-3010
  • Fax: 617-371-3044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: