Healthcare Provider Details

I. General information

NPI: 1598488082
Provider Name (Legal Business Name): EDA VALDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2022
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 AMORY ST
BOSTON MA
02130
US

IV. Provider business mailing address

555 AMORY ST
BOSTON MA
02130-2652
US

V. Phone/Fax

Practice location:
  • Phone: 857-370-7448
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: