Healthcare Provider Details

I. General information

NPI: 1629310214
Provider Name (Legal Business Name): SUFFOLK UNIVERSITY HEALTH AND WELLNESS SERVICES OFFICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2013
Last Update Date: 04/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 TREMONT ST 5TH FLOOR
BOSTON MA
02108-3916
US

IV. Provider business mailing address

8 ASHBURTON PL
BOSTON MA
02108-2701
US

V. Phone/Fax

Practice location:
  • Phone: 617-573-8260
  • Fax:
Mailing address:
  • Phone: 617-573-8260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LS0200X
TaxonomySchool Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE MANNING
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 617-573-8400