Healthcare Provider Details

I. General information

NPI: 1144457656
Provider Name (Legal Business Name): EMILY P.R. NIELDS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2009
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 BROOKLINE PL
BROOKLINE MA
02445-7230
US

IV. Provider business mailing address

300 LONGWOOD AVE
BOSTON MA
02115-5724
US

V. Phone/Fax

Practice location:
  • Phone: 317-355-2727
  • Fax:
Mailing address:
  • Phone: 617-355-4956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number266695
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number291552
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number17778
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: