Healthcare Provider Details

I. General information

NPI: 1386050458
Provider Name (Legal Business Name): MELISSA KAELI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 SOUTH ST
BOSTON MA
02130-3112
US

IV. Provider business mailing address

35 SOUTH ST UNIT 1
BOSTON MA
02130-3112
US

V. Phone/Fax

Practice location:
  • Phone: 617-286-2133
  • Fax: 617-440-2081
Mailing address:
  • Phone: 774-239-8445
  • Fax: 508-625-6570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2293194
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2293194
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: