Healthcare Provider Details

I. General information

NPI: 1548193667
Provider Name (Legal Business Name): HEANNY SANCHEZ ACOSTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 CAMBRIDGEPARK DR
CAMBRIDGE MA
02140-2485
US

IV. Provider business mailing address

1770 MASSACHUSETTS AVE APT 128
CAMBRIDGE MA
02140-2808
US

V. Phone/Fax

Practice location:
  • Phone: 857-415-0026
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLN1005290
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: