Healthcare Provider Details

I. General information

NPI: 1255178083
Provider Name (Legal Business Name): AMELIA FALAVINHA RN, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 07/10/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 BURKESIDE AVE
BROCKTON MA
02301-1454
US

IV. Provider business mailing address

85 BURKESIDE AVE
BROCKTON MA
02301-1454
US

V. Phone/Fax

Practice location:
  • Phone: 617-997-3667
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN277585
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN277585
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: