Healthcare Provider Details

I. General information

NPI: 1669423901
Provider Name (Legal Business Name): DEBORAH SUSAN YOLIN-RALEY PA C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 12/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 BINNEY ST DANA FARBER CANCER INSTITUTE D1B30
BOSTON MA
02115-6084
US

IV. Provider business mailing address

12 FOX MEADOWS LN
WAYLAND MA
01778
US

V. Phone/Fax

Practice location:
  • Phone: 617-549-8714
  • Fax: 617-278-6965
Mailing address:
  • Phone: 508-358-2922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1550
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: