Healthcare Provider Details

I. General information

NPI: 1639773500
Provider Name (Legal Business Name): GEHANE GAJJAOUI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST
BOSTON MA
02115-6110
US

IV. Provider business mailing address

340 WOOD RD STE 305
BRAINTREE MA
02184-2404
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-5000
  • Fax:
Mailing address:
  • Phone: 781-228-6583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2313755
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: