Healthcare Provider Details

I. General information

NPI: 1780881573
Provider Name (Legal Business Name): CHERYL A COLANTONIO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1493 CAMBRIDGE ST
CAMBRIDGE MA
02139-1047
US

IV. Provider business mailing address

283 WAVERLEY AVE
WATERTOWN MA
02472-3240
US

V. Phone/Fax

Practice location:
  • Phone: 617-665-1552
  • Fax: 617-665-1925
Mailing address:
  • Phone: 617-926-2420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number122928
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: