Healthcare Provider Details

I. General information

NPI: 1013540400
Provider Name (Legal Business Name): EVELYSE GEFFRARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EVELYSE DORCELUS

II. Dates (important events)

Enumeration Date: 02/13/2020
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2696
US

IV. Provider business mailing address

60 WESTMORE RD APT 1
MATTAPAN MA
02126-1559
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-4100
  • Fax:
Mailing address:
  • Phone: 781-521-3212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2286267
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: